Provider Demographics
NPI:1407393879
Name:FICKENS, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FICKENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1717
Mailing Address - Country:US
Mailing Address - Phone:206-461-3649
Mailing Address - Fax:206-461-8391
Practice Address - Street 1:2329 4TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1717
Practice Address - Country:US
Practice Address - Phone:206-461-3649
Practice Address - Fax:206-461-8391
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60148588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health