Provider Demographics
NPI:1710448725
Name:VICKERS, HELEN-KATHERINE (LCSW)
Entity type:Individual
Prefix:
First Name:HELEN-KATHERINE
Middle Name:
Last Name:VICKERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATI
Other - Middle Name:
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:96TH MEDICAL GROUP
Mailing Address - Street 2:307 BOATNER ROAD, STE 114
Mailing Address - City:EGLIN AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32542
Mailing Address - Country:US
Mailing Address - Phone:850-503-6833
Mailing Address - Fax:
Practice Address - Street 1:96TH MEDICAL GROUP
Practice Address - Street 2:307 BOATNER ROAD SUITE
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542
Practice Address - Country:US
Practice Address - Phone:850-883-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-31
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040109271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical