Healthcare Provider Details

I. General information

NPI: 1518151380
Provider Name (Legal Business Name): HEATHER ANN HICKOK LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 PROFESSIONAL CT
HAGERSTOWN MD
21740-5852
US

IV. Provider business mailing address

7066 FURNACE RD
WAYNESBORO PA
17268-9744
US

V. Phone/Fax

Practice location:
  • Phone: 301-791-3045
  • Fax: 240-313-3071
Mailing address:
  • Phone: 717-749-7132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13597
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: