Provider Demographics
NPI:1245767839
Name:HICKERSON, MICHAEL (MSW RSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:HICKERSON
Suffix:
Gender:M
Credentials:MSW RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 TEDDY AVE
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-3240
Mailing Address - Country:US
Mailing Address - Phone:504-638-6519
Mailing Address - Fax:
Practice Address - Street 1:7921 BULLARD AVE STE 2C
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70128-1186
Practice Address - Country:US
Practice Address - Phone:504-373-9626
Practice Address - Fax:504-373-9626
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker