Healthcare Provider Details

I. General information

NPI: 1174757348
Provider Name (Legal Business Name): ROSS HICKMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2681 ROCKY RIDGE LN
BIRMINGHAM AL
35216-4809
US

IV. Provider business mailing address

2681 ROCKY RIDGE LN
BIRMINGHAM AL
35216-4809
US

V. Phone/Fax

Practice location:
  • Phone: 205-945-0037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2766
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: