Individual
ALICIA DAWN COCKRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
255 W NAPA ST STE K, SONOMA, CA 95476-6546
(707) 816-2400
Mailing address
255 W NAPA ST STE K, SONOMA, CA 95476-6546
(707) 816-2400
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
103TC0700X
Clinical Psychologist
PSY23519
CA
103TF0000X
Family Psychologist
—
—
103TH0004X
Health Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
103TR0400X
Rehabilitation Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
268623
—
CA
Enumeration date
10/12/2009
Last updated
12/12/2018
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