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1548476104
KELLY LEE WICKHAM
LOS ANGELES, CA
NPI
1548476104
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2007-05-14
Last Update Date
2007-07-08
Business Address
Mrs. KELLY LEE WICKHAM
1147 S ALVARADO ST
LOS ANGELES, CA 90006-4100
Phone number: 213-381-8526
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Mailing Address
Mrs. KELLY LEE WICKHAM
752 GLENWOOD RD
GLENDALE, CA 91202-1575
Phone number: 818-242-9357
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