=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033076807
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEVON DERRICK HICKMAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2026
-----------------------------------------------------
Last Update Date | 01/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 MCGINNESS WAY
-----------------------------------------------------
City | MC KEES ROCKS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15136-3278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-525-8786
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 MCGINNESS WAY
-----------------------------------------------------
City | MC KEES ROCKS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15136-3278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-525-8786
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 027023RH
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------