Provider Demographics
NPI:1255962734
Name:WICAL, ERIN (LCPC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:WICAL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 COMMANDERS WAY N
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21409-5226
Mailing Address - Country:US
Mailing Address - Phone:908-894-0119
Mailing Address - Fax:
Practice Address - Street 1:1016 COMMANDERS WAY N
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21409-5226
Practice Address - Country:US
Practice Address - Phone:443-292-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10212101YM0800X
MDLC12351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty