Provider Demographics
NPI:1881050904
Name:HICKMAN, TONI DEAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:TONI
Middle Name:DEAN
Last Name:HICKMAN
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 1:36 PAXON DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2002
Mailing Address - Country:US
Mailing Address - Phone:302-690-4133
Mailing Address - Fax:
Practice Address - Street 1:1813 MARSH RD
Practice Address - Street 2:STE C
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4544
Practice Address - Country:US
Practice Address - Phone:302-690-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0001046103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical