Provider Demographics
NPI:1427031889
Name:WICK, DAVID THOMAS (MA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:THOMAS
Last Name:WICK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 W NORTHSHORE AVE
Mailing Address - Street 2:#1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626
Mailing Address - Country:US
Mailing Address - Phone:773-262-3425
Mailing Address - Fax:
Practice Address - Street 1:671 N WABASH AVE
Practice Address - Street 2:ST JOHNS CATHEDRAL COUNSELING CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-337-5874
Practice Address - Fax:312-337-9243
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health