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General NPI Number Information
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NPI Number | 1518511807
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Entity Type | Individual
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Provider Name | CALEB HICKERSON
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Gender | Male
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 1729 KINNEYS LN STE 101
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City | PORTSMOUTH
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State | OH
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Zip | 45662-3166
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Country | US
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Telephone | 740-529-2440
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Fax |
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Provider Business Mailing Address
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Address Line | 411 COURT ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-3932
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Country | US
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Telephone | 740-354-6685
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.1904077
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | I.2203992
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.2203992
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License Number State | OH
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