Provider Demographics
NPI:1700086527
Name:WICK, JULIA A (MS, LCMHC)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:A
Last Name:WICK
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE WINOOSKI PARK BOX 264
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05439-0001
Mailing Address - Country:US
Mailing Address - Phone:802-654-2549
Mailing Address - Fax:802-654-2539
Practice Address - Street 1:123 ETHAN ALLEN AVE STE 201
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3311
Practice Address - Country:US
Practice Address - Phone:802-734-0321
Practice Address - Fax:802-654-2539
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000420101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT61996OtherMVP
VT39569OtherBCBS
VT1007193Medicaid