Provider Demographics
NPI:1588966980
Name:HICKMAN, DAVID NEAL (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:NEAL
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5013 VERONA DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4176
Mailing Address - Country:US
Mailing Address - Phone:510-685-7879
Mailing Address - Fax:
Practice Address - Street 1:5013 VERONA DR
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4176
Practice Address - Country:US
Practice Address - Phone:510-685-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25559103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY25559OtherCALIFORNIA BOARD OF PSYCHOLOGY