=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568288710
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARKAY HICKERSON, LCSW, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2024
-----------------------------------------------------
Last Update Date | 12/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1221 JUDSON RD STE 100
-----------------------------------------------------
City | LONGVIEW
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75601-3922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-215-3799
-----------------------------------------------------
Fax | 903-616-8017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2503 NORTHHAVEN DR
-----------------------------------------------------
City | LONGVIEW
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75605-2345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-215-3799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. MARKAY HICKERSON
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 903-215-3799
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------