Individual
TINA MARIE HICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
5525 TWIN KNOLLS RD, SUITE 321, COLUMBIA, MD 21045-3266
(240) 459-3044
Mailing address
9080 MOONSHINE HOLW APT A, LAUREL, MD 20723-1638
(240) 459-3044
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
M04294
MD
Other
Enumeration date
09/21/2012
Last updated
09/21/2012
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