Provider Demographics
NPI:1346713435
Name:HICKSON, TIANA NICOLE (MSW)
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:NICOLE
Last Name:HICKSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 CATA RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23040-3003
Mailing Address - Country:US
Mailing Address - Phone:434-825-7665
Mailing Address - Fax:
Practice Address - Street 1:941 GLENWOOD STATION LN STE 204
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-5719
Practice Address - Country:US
Practice Address - Phone:434-995-5367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
VA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker