Active NPI
Tim J McVicker, CADAC II
- Addiction (Substance Use Disorder) Counselor
- Wabash, IN
National Provider Identifier
1154416709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- A1431R
- Practice address
- 255 N. Miami St.
Wabash, IN 46992 - Phone
- (260) 563-8446
- Fax
- (260) 563-1902
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | A1431R | IN | Primary |
Addresses
Primary practice location
255 N. Miami St.
Wabash, IN 46992
Mailing address
850 N. Harrison St.
Warsaw, IN 46580
Phone (574) 267-7169
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A1431R | IN | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154416709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "850 N. HARRISON ST.",
"city": "WARSAW",
"state": "IN",
"postal_code": "46580",
"telephone_number": "574-267-7169",
"fax_number": "574-269-3995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 N. MIAMI ST.",
"city": "WABASH",
"state": "IN",
"postal_code": "46992",
"telephone_number": "260-563-8446",
"fax_number": "260-563-1902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCVICKER",
"first_name": "TIM",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "CADAC II",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IN",
"license": "A1431R",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wabash, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.