Individual
BLAIR HAREN HICKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSSW LCSW
Contact information
Practice address
926 W OAKLAND AVE, SUITE 226, JOHNSON CITY, TN 37604-1445
(423) 262-0317
(423) 262-0311
Mailing address
926 W OAKLAND AVE, SUITE 226, JOHNSON CITY, TN 37604-1445
(423) 262-0317
(423) 262-0311
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW3260
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100676
UBH-HEALTHPLAN
—
01
—
1047231
CIGNA-MCC
—
01
—
3085266
MAGELLAN SUMMIT
—
01
—
351654200
DOL WORKERS COMP
—
01
—
3697987
MEDICARE-TN
—
Enumeration date
09/11/2006
Last updated
08/12/2010
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