Provider Demographics
NPI:1205201860
Name:HICKERSON, ROZIE' (MPA)
Entity Type:Individual
Prefix:
First Name:ROZIE'
Middle Name:
Last Name:HICKERSON
Suffix:
Gender:F
Credentials:MPA
Other - Prefix:
Other - First Name:ROMELL
Other - Middle Name:
Other - Last Name:HICKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPA
Mailing Address - Street 1:2601 TULANE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-7499
Mailing Address - Country:US
Mailing Address - Phone:504-281-4453
Mailing Address - Fax:504-281-4412
Practice Address - Street 1:2601 TULANE AVE STE 300
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7499
Practice Address - Country:US
Practice Address - Phone:504-281-4453
Practice Address - Fax:504-281-4412
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator