Healthcare Provider Details

I. General information

NPI: 1548189764
Provider Name (Legal Business Name): SAMMI'S CORNER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89012-6019
US

IV. Provider business mailing address

1070 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89012-6019
US

V. Phone/Fax

Practice location:
  • Phone: 702-479-6319
  • Fax: 725-280-5343
Mailing address:
  • Phone: 702-479-6319
  • Fax: 725-280-5343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL JAVAR HICKSON
Title or Position: OWNER/FOUNDER
Credential: PHD, LCSW, NPT-C
Phone: 702-265-7427