Provider Demographics
NPI:1518158823
Name:VICKERS, WHITBURN ALBERT (MS)
Entity Type:Individual
Prefix:MR
First Name:WHITBURN
Middle Name:ALBERT
Last Name:VICKERS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MISS
Other - First Name:WHITBURN
Other - Middle Name:ALBERT
Other - Last Name:VICKERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:2814 S US HIGHWAY 1
Mailing Address - Street 2:SUITE D4
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-8120
Mailing Address - Country:US
Mailing Address - Phone:772-221-8585
Mailing Address - Fax:772-221-8371
Practice Address - Street 1:2814 S US HIGHWAY 1
Practice Address - Street 2:SUITE D4
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-8120
Practice Address - Country:US
Practice Address - Phone:772-221-8585
Practice Address - Fax:772-221-8371
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker