Provider Demographics
NPI:1639833304
Name:WICKLEIN JOYCE, DIANNE PATRICIA
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:PATRICIA
Last Name:WICKLEIN JOYCE
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 1:8420 ICE CRYSTAL DR UNIT N
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-2066
Mailing Address - Country:US
Mailing Address - Phone:301-830-1241
Mailing Address - Fax:
Practice Address - Street 1:8737 COLESVILLE RD STE 700
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-7901
Practice Address - Country:US
Practice Address - Phone:240-296-5934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health