Healthcare Provider Details

I. General information

NPI: 1619801404
Provider Name (Legal Business Name): EMMIN BICKFORD LCSW
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4807 HERMITAGE RD
RICHMOND VA
23227-3335
US

IV. Provider business mailing address

11400 LONG MEADOW DR
GLEN ALLEN VA
23059-5101
US

V. Phone/Fax

Practice location:
  • Phone: 804-554-1767
  • Fax:
Mailing address:
  • Phone: 804-554-1767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020599
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: