Provider Demographics
NPI:1891450631
Name:PICKENS, DAVID MILES (PSYD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MILES
Last Name:PICKENS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4944 WINDPLAY DR STE 320
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9310
Mailing Address - Country:US
Mailing Address - Phone:916-933-4195
Mailing Address - Fax:
Practice Address - Street 1:4944 WINDPLAY DR STE 320
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9310
Practice Address - Country:US
Practice Address - Phone:916-933-4195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18980103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist