Provider Demographics
NPI:1528385929
Name:WICKER, DARON (MA, LMHCA)
Entity Type:Individual
Prefix:MR
First Name:DARON
Middle Name:
Last Name:WICKER
Suffix:
Gender:M
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27484 254TH WAY SE
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-2044
Mailing Address - Country:US
Mailing Address - Phone:425-890-1646
Mailing Address - Fax:
Practice Address - Street 1:27484 254TH WAY SE
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-2044
Practice Address - Country:US
Practice Address - Phone:425-890-1646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60129755101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health