Provider Demographics
NPI:1386191690
Name:HICKMAN-EVANS, COLETTE (LCSW, PHD)
Entity type:Individual
Prefix:DR
First Name:COLETTE
Middle Name:
Last Name:HICKMAN-EVANS
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 E 1000 S STE D
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3716
Mailing Address - Country:US
Mailing Address - Phone:801-899-2559
Mailing Address - Fax:
Practice Address - Street 1:481 E 1000 S STE D
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3716
Practice Address - Country:US
Practice Address - Phone:801-899-2559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10500203-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical