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1366594202
DAVID LEE WICKSTROM
COLUMBIA, SC
NPI
1366594202
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
103TC0700X Psychologist, Clinical
(Licence: SC 0591)
Enumeration Date
2007-01-18
Last Update Date
2007-07-08
Business Address
Dr. DAVID LEE WICKSTROM Psychologist
7520 MONTICELLO RD
COLUMBIA, SC 29203-1516
Phone number: 803-254-3313
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Mailing Address
Dr. DAVID LEE WICKSTROM Psychologist
420 LONGTOWN RD W
BLYTHEWOOD, SC 29016-9450
Phone number: 803-318-2009
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