Individual
DORETHA HICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
125 E CHEVES ST, FLORENCE, SC 29506-2526
(843) 317-4073
(843) 317-4096
Mailing address
125 E CHEVES ST, FLORENCE, SC 29506-2526
(843) 317-4073
(843) 317-4096
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205925567
—
SC
Enumeration date
09/21/2021
Last updated
09/21/2021
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