Provider Demographics
NPI:1255473211
Name:LEVINSON WICKHAM, TERRILL SHARON (PHD)
Entity type:Individual
Prefix:DR
First Name:TERRILL
Middle Name:SHARON
Last Name:LEVINSON WICKHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TERRILL
Other - Middle Name:SHARON
Other - Last Name:LEVINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1210 NEVADA ST
Mailing Address - Street 2:SUITE101
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2895
Mailing Address - Country:US
Mailing Address - Phone:909-793-8312
Mailing Address - Fax:909-792-6507
Practice Address - Street 1:1210 NEVADA ST
Practice Address - Street 2:SUITE101
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2895
Practice Address - Country:US
Practice Address - Phone:909-793-8312
Practice Address - Fax:909-792-6507
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8407103TA0700X, 103TB0200X, 103TC0700X, 103TC2200X, 103TM1800X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist