Provider Demographics
NPI:1740866011
Name:WICKETT, ABBIE LEIGH (LCPC)
Entity type:Individual
Prefix:MS
First Name:ABBIE
Middle Name:LEIGH
Last Name:WICKETT
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:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0356
Mailing Address - Country:US
Mailing Address - Phone:207-249-0435
Mailing Address - Fax:
Practice Address - Street 1:235 CENTER ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1961
Practice Address - Country:US
Practice Address - Phone:067-561-9496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC7099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional