Provider Demographics
NPI:1790071678
Name:WICKER, DEBRA KAY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:KAY
Last Name:WICKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 E. MERRITT ISLAND CSWY SUITE 230
Mailing Address - Street 2:LUKE & ASSOCIATES
Mailing Address - City:MERRIT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952
Mailing Address - Country:US
Mailing Address - Phone:321-452-4601
Mailing Address - Fax:866-919-6432
Practice Address - Street 1:310 W LOSEY ST
Practice Address - Street 2:SCOTT AFB
Practice Address - City:SCOTT AFB
Practice Address - State:IL
Practice Address - Zip Code:62225
Practice Address - Country:US
Practice Address - Phone:618-256-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002006045LCSW104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker