Provider Demographics
NPI:1689713059
Name:PICKLE, DEVONA VICKERS (LMHC, NCC)
Entity Type:Individual
Prefix:MS
First Name:DEVONA
Middle Name:VICKERS
Last Name:PICKLE
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E PARK AVE
Mailing Address - Street 2:BUILDING A
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-2610
Mailing Address - Country:US
Mailing Address - Phone:850-561-8060
Mailing Address - Fax:850-561-1143
Practice Address - Street 1:820 E PARK AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2610
Practice Address - Country:US
Practice Address - Phone:850-561-8060
Practice Address - Fax:850-561-1143
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6525101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health