Provider Demographics
NPI:1942349535
Name:FABELLA-HICKS, VERNA (PHD)
Entity Type:Individual
Prefix:DR
First Name:VERNA
Middle Name:
Last Name:FABELLA-HICKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2881 BUSINESS PARK CT STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-9020
Mailing Address - Country:US
Mailing Address - Phone:702-508-2112
Mailing Address - Fax:702-965-4587
Practice Address - Street 1:2881 BUSINESS PARK CT STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-508-2112
Practice Address - Fax:702-965-4587
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19774103TC0700X
NVPY0537103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100511711Medicaid