Provider Demographics
NPI:1134904642
Name:HICKSON, JONIESHA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JONIESHA
Middle Name:
Last Name:HICKSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GALLOWAY ST NE APT 118N
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-6443
Mailing Address - Country:US
Mailing Address - Phone:201-780-8811
Mailing Address - Fax:
Practice Address - Street 1:725 19TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4713
Practice Address - Country:US
Practice Address - Phone:202-572-1017
Practice Address - Fax:202-986-9240
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSYA200001219103TC0700X
101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical