Provider Demographics
NPI:1407199623
Name:WIRICK, DINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:
Last Name:WIRICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 HENSON CT
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-5023
Mailing Address - Country:US
Mailing Address - Phone:509-338-5325
Mailing Address - Fax:
Practice Address - Street 1:725 HENSON CT
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-5023
Practice Address - Country:US
Practice Address - Phone:509-338-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24608103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical