Individual
JAMIE HICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
124 SLADE AVE STE 101, BALTIMORE, MD 21208-4900
(443) 680-7931
Mailing address
4103 CALLAWAY AVE, BALTIMORE, MD 21215-6113
(443) 680-7931
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LGP10322
MD
101YM0800X
Mental Health Counselor
LGP10322
MD
Other
Enumeration date
03/31/2020
Last updated
03/31/2020
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