Provider Demographics
NPI:1225343460
Name:HICKSON, LAUREN M (LPC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:HICKSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 WAKELEE AVE
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1198
Mailing Address - Country:US
Mailing Address - Phone:203-503-3650
Mailing Address - Fax:203-503-3659
Practice Address - Street 1:121 WAKELEE AVE
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1198
Practice Address - Country:US
Practice Address - Phone:203-503-3650
Practice Address - Fax:203-503-3659
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002212101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid