Provider Demographics
NPI:1902024698
Name:WICKHAM, CATHY ANN (MFT)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:ANN
Last Name:WICKHAM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 DORADO TER
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1740
Mailing Address - Country:US
Mailing Address - Phone:415-821-7248
Mailing Address - Fax:415-494-5913
Practice Address - Street 1:3890 24TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3839
Practice Address - Country:US
Practice Address - Phone:415-821-7248
Practice Address - Fax:415-494-5913
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT13014106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist