Provider Demographics
NPI:1912037334
Name:WICKNER, FRAN S (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:FRAN
Middle Name:S
Last Name:WICKNER
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350-A SOLANO AVENUE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706
Mailing Address - Country:US
Mailing Address - Phone:510-527-4011
Mailing Address - Fax:510-527-4011
Practice Address - Street 1:1350 A SOLANO AVENUE
Practice Address - Street 2:SUITE #4
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706
Practice Address - Country:US
Practice Address - Phone:510-527-4011
Practice Address - Fax:510-527-4011
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC18676106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist