Provider Demographics
NPI:1952946196
Name:LILLY, ALLENE WICKER (LCSW)
Entity Type:Individual
Prefix:
First Name:ALLENE
Middle Name:WICKER
Last Name:LILLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3693 S 800 E
Mailing Address - Street 2:
Mailing Address - City:WALDRON
Mailing Address - State:IN
Mailing Address - Zip Code:46182-9513
Mailing Address - Country:US
Mailing Address - Phone:765-561-5605
Mailing Address - Fax:
Practice Address - Street 1:18 E MAIN ST STE 216
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-5541
Practice Address - Country:US
Practice Address - Phone:317-649-4311
Practice Address - Fax:317-649-4375
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN58871041C0700X
IN34008247A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical