Healthcare Provider Details

I. General information

NPI: 1922945476
Provider Name (Legal Business Name): TOLETA MICHELLE HICKERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

694 WILLIAMS AVE
MEMPHIS TN
38126-5812
US

IV. Provider business mailing address

9261 ALCOVE ST
CORDOVA TN
38016-2092
US

V. Phone/Fax

Practice location:
  • Phone: 662-985-0767
  • Fax:
Mailing address:
  • Phone: 662-985-0767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: