Organization
AZITA HICKEY PH D PSYCHOLOGIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AZITA HICKEY PHD (OFFICER/PRESIDENT)
(909) 957-0556
Entity
Organization
Contact information
Practice address
2831 CAMINO DEL RIO S STE 103, SAN DIEGO, CA 92108-3827
(619) 880-9008
(909) 660-4997
Mailing address
9921 CARMEL MOUNTAIN RD STE 204, SAN DIEGO, CA 92129-2813
(619) 880-9008
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PSY30683
LICENSE, CLINICAL PSYCHOLOGIST
CA
Enumeration date
02/13/2019
Last updated
04/29/2024
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