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NPI Code Detail

MEDICARE: DAVID HICKERSON BS, CADC II, QMHA

MEDICARE: DAVID HICKERSON BS, CADC II, QMHA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorOR
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1841658986
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID HICKERSON BS, CADC II, QMHA
Provider Business Mailing Address
First Line : 78 CENTENNIAL LOOP STE A
Second Line :
City : EUGENE
State : OR
Zip : 97401-7900
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1856 GRAND PRAIRIE RD SE
Second Line :
City : ALBANY
State : OR
Zip : 97322-5521
Country : US
Telephone Number : 541-393-0777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2016
Last Update Date : 09/23/2020

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