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General NPI Number Information
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NPI Number | 1992809909
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Entity Type | Individual
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Provider Name | BLAIR HAREN HICKMAN MSSW LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 08/12/2010
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Provider Practice Location Address
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Address Line | 926 W OAKLAND AVE SUITE 226
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City | JOHNSON CITY
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State | TN
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Zip | 37604-1445
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Country | US
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Telephone | 423-262-0317
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Fax | 423-262-0311
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Provider Business Mailing Address
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Address Line | 926 W OAKLAND AVE SUITE 226
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City | JOHNSON CITY
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State | TN
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Zip | 37604-1445
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Country | US
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Telephone | 423-262-0317
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Fax | 423-262-0311
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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 | LSW3260
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License Number State | TN
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