| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 5925 Omaha St, Reno, Nevada |
| Authorized Official Name and Position | Alonzo Hickerson (OWNER OPERATOR) |
| Authorized Official Contact | 7753790748 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2300 Harvard Way # 105 Reno NV 89502-4002 Ph: (775) 379-0748 | 5925 Omaha St Reno NV 89506-8813 Ph: (775) 379-0748 |
| NPI Number | 1619254299 |
|---|---|
| Provider Enumeration Date | 11/09/2011 |
| Last Update Date | 11/09/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619254299 | NPI | - | NPPES |
| 1619008281 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | C-2101 (Nevada) | Secondary |
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