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NPI Code Detail

MEDICARE: MS. MARIELLE VAUGHN-HICKMAN M.A.

MEDICARE: MS. MARIELLE VAUGHN-HICKMAN M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1578686523
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARIELLE VAUGHN-HICKMAN M.A.
Provider Business Mailing Address
First Line : 8233 E STOCKTON BLVD
Second Line :
City : SACRAMENTO
State : CA
Zip : 95828-8203
Country : US
Telephone Number : 916-705-9970
Fax Number :
Provider Business Practice Location Address
First Line : 8233 E STOCKTON BLVD
Second Line : D
City : SACRAMENTO
State : CA
Zip : 95828-8203
Country : US
Telephone Number : 916-236-4700
Fax Number : 916-405-6551
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2007
Last Update Date : 07/27/2011

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