Provider Demographics
NPI:1467720474
Name:MCVICKER, WILLIAM RAYMOND (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RAYMOND
Last Name:MCVICKER
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13810 CLIMBING WAY
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9649
Mailing Address - Country:US
Mailing Address - Phone:530-273-1112
Mailing Address - Fax:530-273-1112
Practice Address - Street 1:729 SUNRISE AVE
Practice Address - Street 2:SUITE 601
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4565
Practice Address - Country:US
Practice Address - Phone:530-273-1112
Practice Address - Fax:530-273-1112
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2014-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50728106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist