Provider Demographics
NPI:1326516907
Name:HICKMAN, KATLYN DEVON (LBA)
Entity Type:Individual
Prefix:MS
First Name:KATLYN
Middle Name:DEVON
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:VA
Mailing Address - Zip Code:24416-3026
Mailing Address - Country:US
Mailing Address - Phone:540-461-0666
Mailing Address - Fax:540-462-2892
Practice Address - Street 1:2424 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:VA
Practice Address - Zip Code:24416-3026
Practice Address - Country:US
Practice Address - Phone:540-461-0666
Practice Address - Fax:540-462-2892
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001227103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst