Provider Demographics
NPI:1508909425
Name:LICKEL, ROBIN L (LPC CSAC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:LICKEL
Suffix:
Gender:F
Credentials:LPC CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 KESSEL CT STE 105
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6227
Mailing Address - Country:US
Mailing Address - Phone:608-280-2429
Mailing Address - Fax:608-280-4750
Practice Address - Street 1:25 KESSEL CT STE 105
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-6227
Practice Address - Country:US
Practice Address - Phone:608-280-2429
Practice Address - Fax:608-280-4750
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15268-132101YA0400X
WI436-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)