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General NPI Number Information
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NPI Number | 1912306911
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Entity Type | Individual
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Provider Name | MR. RICHARD STICKNEY
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Gender | Male
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 08/15/2014
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Provider Practice Location Address
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Address Line | 1290 NAVAREE DR
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City | DELTONA
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State | FL
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Zip | 32738-6959
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Country | US
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Telephone | 386-848-1402
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 390455
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City | DELTONA
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State | FL
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Zip | 32739-0455
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH4005
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN3414332
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License Number State | FL
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