Provider Demographics
NPI:1154619617
Name:SCHULTZ-HICKERSON, CHARLEEN (PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:CHARLEEN
Middle Name:
Last Name:SCHULTZ-HICKERSON
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:DR
Other - First Name:CHAR
Other - Middle Name:
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHOLOGIST
Mailing Address - Street 1:1600 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814
Mailing Address - Country:US
Mailing Address - Phone:916-654-2657
Mailing Address - Fax:916-653-6376
Practice Address - Street 1:1600 9TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814
Practice Address - Country:US
Practice Address - Phone:916-654-2657
Practice Address - Fax:916-653-6376
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15748103T00000X
CA15748103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist