Provider Demographics
NPI:1154726370
Name:PICKETT, DENORVIOUS JR
Entity type:Individual
Prefix:
First Name:DENORVIOUS
Middle Name:
Last Name:PICKETT
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 E PALMDALE BLVD STE 2802
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93590-6500
Mailing Address - Country:US
Mailing Address - Phone:310-270-2627
Mailing Address - Fax:
Practice Address - Street 1:2220 E PALMDALE BLVD STE 2802
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93590-6500
Practice Address - Country:US
Practice Address - Phone:310-270-2627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YP1600X, 104100000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No104100000XBehavioral Health & Social Service ProvidersSocial Worker