Provider Demographics
NPI:1952181562
Name:WICK, CAITLIN (LGPC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:WICK
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 HARVARD ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2319
Mailing Address - Country:US
Mailing Address - Phone:202-930-2335
Mailing Address - Fax:
Practice Address - Street 1:1822 HARVARD ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2319
Practice Address - Country:US
Practice Address - Phone:029-302-3352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14245101YM0800X
DCLGPC200001548101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health