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General NPI Number Information
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NPI Number | 1194735928
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Entity Type | Individual
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Provider Name | JULIE HICKSON LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 02/13/2020
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Provider Practice Location Address
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Address Line | 605 MAIN ST STE 203
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City | STEVENSVILLE
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State | MD
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Zip | 21666-2029
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Country | US
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Telephone | 410-758-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 127 ANDREW CT
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City | CENTREVILLE
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State | MD
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Zip | 21617-2539
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Country | US
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Telephone | 410-758-4800
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Fax | 443-262-9697
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10866
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License Number State | MD
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