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General NPI Number Information
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NPI Number | 1346435633
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Entity Type | Individual
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Provider Name | LATICIA BICKHAM LPC
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Gender | Female
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 02/23/2011
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Provider Practice Location Address
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Address Line | 2901 PINE BLUFF RD
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City | NEWTON
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State | MS
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Zip | 39345
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Country | US
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Telephone | 601-479-0264
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Fax |
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Provider Business Mailing Address
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Address Line | 5360 16TH AVE
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City | MERIDIAN
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State | MS
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Zip | 39305-1709
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Country | US
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Telephone | 601-479-0264
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1292
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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