Provider Demographics
NPI:1578686523
Name:VAUGHN-HICKMAN, MARIELLE (MA)
Entity Type:Individual
Prefix:MS
First Name:MARIELLE
Middle Name:
Last Name:VAUGHN-HICKMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8233 E STOCKTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-8203
Mailing Address - Country:US
Mailing Address - Phone:916-705-9970
Mailing Address - Fax:
Practice Address - Street 1:8233 E STOCKTON BLVD
Practice Address - Street 2:D
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-8203
Practice Address - Country:US
Practice Address - Phone:916-236-4700
Practice Address - Fax:916-405-6551
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist