Provider Demographics
NPI:1508350125
Name:WHICKER, DANE ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANE
Middle Name:ROBERT
Last Name:WHICKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:DANE
Other - Middle Name:ROBERT
Other - Last Name:WHICKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:DUMC BOX 3026
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710
Mailing Address - Country:US
Mailing Address - Phone:919-684-1131
Mailing Address - Fax:919-684-6770
Practice Address - Street 1:2213 ELBA ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3934
Practice Address - Country:US
Practice Address - Phone:919-684-1131
Practice Address - Fax:919-684-6770
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5357103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical