Provider Demographics
NPI:1396556965
Name:CLEVELAND HICKLES, NAKITA DOMINIQUE (LPC)
Entity type:Individual
Prefix:
First Name:NAKITA
Middle Name:DOMINIQUE
Last Name:CLEVELAND HICKLES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:NAKITA
Other - Middle Name:D
Other - Last Name:HICKLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2909 N 52ND ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1610
Mailing Address - Country:US
Mailing Address - Phone:414-460-8716
Mailing Address - Fax:
Practice Address - Street 1:5555 N PORT WASHINGTON RD STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4927
Practice Address - Country:US
Practice Address - Phone:262-999-3495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10085-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional