Provider Demographics
NPI:1568804227
Name:WICKS, JUDITH
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:WICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 WAIMANU ST
Mailing Address - Street 2:STE. 624
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5248
Mailing Address - Country:US
Mailing Address - Phone:808-791-6713
Mailing Address - Fax:808-791-6081
Practice Address - Street 1:875 WAIMANU ST
Practice Address - Street 2:STE. 624
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5248
Practice Address - Country:US
Practice Address - Phone:808-791-6713
Practice Address - Fax:808-791-6081
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health