| Doctor Name: | DEANNA HICKENBOTHAM |
| NPI Number: | 1083766802 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC |
| License Number: | MH3009 |
| Business Practice Address: | 7 Vine Ave Ne Fort Walton Beach, FL - 325485070 |
| Business Phone Number: | 8508632873 |
| Business Fax Number: | 8508629292 |
| Mailing Address: | 259 E Oakdale Ave, CRESTVIEW |
| State: | FL |
| Postal Code: | 325393547 |
| Phone Number: | 8506821234 |
| Fax Number: | 8506898799 |
| NPI Enumeration Date: | 01/18/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH3009 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |