Provider Demographics
NPI:1629686936
Name:WICKHAM, DABNEY TAYLOR
Entity Type:Individual
Prefix:
First Name:DABNEY
Middle Name:TAYLOR
Last Name:WICKHAM
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 1:1916 SAINT CATHERINE CIR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-6502
Mailing Address - Country:US
Mailing Address - Phone:912-391-8639
Mailing Address - Fax:
Practice Address - Street 1:5618 WHITE BLUFF RD STE C
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5520
Practice Address - Country:US
Practice Address - Phone:337-205-9357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health