Provider Demographics
NPI:1083365589
Name:HICKSON, SAMUEL (PHD, LMSW, MSSA)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:HICKSON
Suffix:
Gender:M
Credentials:PHD, LMSW, MSSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6879 W CHARLESTON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1672
Mailing Address - Country:US
Mailing Address - Phone:702-608-4220
Mailing Address - Fax:
Practice Address - Street 1:6879 W CHARLESTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1672
Practice Address - Country:US
Practice Address - Phone:702-608-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-16
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVIC-1898OtherSTATE OF NEVADA BOARD OF SOCIAL WORK