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General NPI Number Information
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NPI Number | 1134904642
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Entity Type | Individual
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Provider Name | JONIESHA HICKSON PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2023
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 725 19TH ST NE
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City | WASHINGTON
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State | DC
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Zip | 20002-4713
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Country | US
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Telephone | 202-572-1017
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Fax | 202-986-9240
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Provider Business Mailing Address
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Address Line | 400 GALLOWAY ST NE APT 118N
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City | WASHINGTON
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State | DC
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Zip | 20011-6443
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Country | US
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Telephone | 201-780-8811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSYA200001219
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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