Individual
MRS. RUTH TRACEY HICKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
4131 NW 13TH ST STE 206, GAINESVILLE, FL 32609-1863
(352) 505-2840
Mailing address
1325 SE 19TH TER, GAINESVILLE, FL 32641-0710
(352) 246-5088
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
MH16904
FL
101YA0400X
Addiction (Substance Use Disorder) Counselor
MH16904
FL
101YM0800X
Mental Health Counselor
MH16904
FL
Other
Enumeration date
11/11/2019
Last updated
11/11/2019
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