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General NPI Number Information
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NPI Number | 1396556965
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Entity Type | Individual
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Provider Name | NAKITA DOMINIQUE CLEVELAND HICKLES LPC
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Gender | Female
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 5555 N PORT WASHINGTON RD STE 200
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City | GLENDALE
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State | WI
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Zip | 53217-4927
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Country | US
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Telephone | 262-999-3495
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Fax |
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Provider Business Mailing Address
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Address Line | 2909 N 52ND ST
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City | MILWAUKEE
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State | WI
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Zip | 53210-1610
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Country | US
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Telephone | 414-460-8716
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10085-125
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License Number State | WI
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