Provider Demographics
NPI:1649443482
Name:WICKER, DENNIS (LPC)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:WICKER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 W RALPH HALL PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-8701
Mailing Address - Country:US
Mailing Address - Phone:903-286-0896
Mailing Address - Fax:
Practice Address - Street 1:935 W RALPH HALL PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-8701
Practice Address - Country:US
Practice Address - Phone:903-286-0896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19977101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193257603Medicaid