Provider Demographics
NPI:1912246349
Name:WICKER, RACHEL LYNN
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LYNN
Last Name:WICKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EXECUTIVE CENTER DR
Mailing Address - Street 2:STE. 120
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-8412
Mailing Address - Country:US
Mailing Address - Phone:843-725-8258
Mailing Address - Fax:803-896-8279
Practice Address - Street 1:101 EXECUTIVE CENTER DR
Practice Address - Street 2:STE. 120
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-8412
Practice Address - Country:US
Practice Address - Phone:843-725-8258
Practice Address - Fax:803-896-8279
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator