Provider Demographics
NPI:1477939460
Name:WYRICK, KATHY DIANE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:DIANE
Last Name:WYRICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 MISTY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24739-6453
Mailing Address - Country:US
Mailing Address - Phone:304-320-0498
Mailing Address - Fax:
Practice Address - Street 1:616 HARRISON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3141
Practice Address - Country:US
Practice Address - Phone:304-487-3487
Practice Address - Fax:681-282-5441
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1868101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional