Provider Demographics
NPI:1083299762
Name:HICKMAN, JAMES DAVID (MMF)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:MMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 MOLINO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-4759
Mailing Address - Country:US
Mailing Address - Phone:310-962-0760
Mailing Address - Fax:
Practice Address - Street 1:3939 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3536
Practice Address - Country:US
Practice Address - Phone:562-473-0827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor