Provider Demographics
NPI:1720439482
Name:MILLICAN, VICKI DIANE (PHD)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:DIANE
Last Name:MILLICAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:VICKI
Other - Middle Name:D
Other - Last Name:MILLICAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:616 RAFORD HILL LN
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3561
Mailing Address - Country:US
Mailing Address - Phone:214-546-8131
Mailing Address - Fax:
Practice Address - Street 1:1025 S JUPITER RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-7708
Practice Address - Country:US
Practice Address - Phone:972-272-4429
Practice Address - Fax:972-494-2812
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10318101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional