Healthcare Provider Details

I. General information

NPI: 1033287198
Provider Name (Legal Business Name): JAMES LYLE HICKMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 COMMERCE AVE
CULLMAN AL
35055-6151
US

IV. Provider business mailing address

1909 COMMERCE AVE
CULLMAN AL
35055-6151
US

V. Phone/Fax

Practice location:
  • Phone: 256-734-4688
  • Fax:
Mailing address:
  • Phone: 256-734-4688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2065C
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2065C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: