Tracylynn Huntley Wickham, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904006713 Issued in VA

Practice address

5412 Glenside Dr Ste F
Richmond, VA 23228-3995

Phone

(804) 282-5880

Fax

(804) 288-2029

NPI assigned

Aug 3, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Dominion Outpatient Services LLCGroup PAC ID 5395996920, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dominion Outpatient Services, LLC

  • Clinical Social Worker
  • Richmond, VA
  • NPI 1790932911
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567555200000",
    "number": "1194003459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 E PARHAM RD",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232282368",
            "telephone_number": "804-272-2000",
            "fax_number": "804-272-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5412 GLENSIDE DR STE F",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232283995",
            "telephone_number": "804-282-5880",
            "fax_number": "804-288-2029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKHAM",
        "first_name": "TRACYLYNN",
        "middle_name": "HUNTLEY",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-03",
        "last_updated": "2019-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904006713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael J Whyte, D.D.S.
• Christina Wical, PMHNP-BC, WHNP-BC
• Wickham Titus Hendrix and Turner PTRS
• Edmond P Wickham III, M.D.
• James R Wickham, M.D.
• Carey Lynn Wickizer, OTR/L
• Kyle Allen Wickliff
• Samantha Wickman, MD
• Haley Wideman, MOT
• Michelle Nancy Widholm, PHARM.D

• Clinical Social Worker in Richmond, VA
• Providers in Richmond, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.