Provider Demographics
NPI:1083365589
Name:HICKSON, SAMUEL (PHD, LCSW, NPT-C)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:HICKSON
Suffix:
Gender:
Credentials:PHD, LCSW, NPT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6879 W CHARLESTON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1672
Mailing Address - Country:US
Mailing Address - Phone:702-608-4220
Mailing Address - Fax:
Practice Address - Street 1:2480 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2719
Practice Address - Country:US
Practice Address - Phone:702-608-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-16
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11811-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV11811-COtherSTATE OF NEVADA BOARD OF SOCIAL WORK