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General NPI Number Information
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NPI Number | 1285875898
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Entity Type | Individual
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Provider Name | GERALDINE HICKERSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/11/2009
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 1239 WOODLAND DR STE 110
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-3723
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Country | US
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Telephone | 270-312-9655
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Fax |
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Provider Business Mailing Address
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Address Line | 611 PEACEFUL DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-6465
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Country | US
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Telephone | 270-317-2880
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Fax |
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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 | KY3394
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License Number State | KY
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