Healthcare Provider Details

I. General information

NPI: 1588321558
Provider Name (Legal Business Name): ALYSON HICKMAN NUTRITION COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2021
Last Update Date: 11/24/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 CREEKBED CIR
SALISBURY MD
21804-7521
US

IV. Provider business mailing address

PO BOX 5181
SALISBURY MD
21802-5181
US

V. Phone/Fax

Practice location:
  • Phone: 757-894-8347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ALYSON HICKMAN
Title or Position: OWNER
Credential: RD, LDN, CDCES
Phone: 757-894-8347