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NPI Code Detail

MEDICARE: MRS. TRACY ELAINE HICKMAN CRC, LPC, LCAS

MEDICARE: MRS. TRACY ELAINE HICKMAN CRC, LPC, LCAS
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) Counselor1583NC
2101YM0800XMental Health Counselor3194NC

General Provider Information

NPI Number : 1851611404
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TRACY ELAINE HICKMAN CRC, LPC, LCAS
Provider Business Mailing Address
First Line : 5820 E WT HARRIS BLVD
Second Line : SUITE 211
City : CHARLOTTE
State : NC
Zip : 28215-3541
Country : US
Telephone Number : 704-566-3410
Fax Number : 704-537-1226
Provider Business Practice Location Address
First Line : 5820 E WT HARRIS BLVD
Second Line : SUITE 211
City : CHARLOTTE
State : NC
Zip : 28215-3541
Country : US
Telephone Number : 704-566-3410
Fax Number : 704-537-1226
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2010
Last Update Date : 06/06/2010

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