Provider Demographics
NPI:1437288503
Name:HICKERSON, DOROTHY LAURICE (CSW)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:LAURICE
Last Name:HICKERSON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:MS
Other - First Name:DOROTHY
Other - Middle Name:LAURICE
Other - Last Name:HICKERSON-HIPSHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:460 SPRING ST.
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130
Mailing Address - Country:US
Mailing Address - Phone:812-280-2080
Mailing Address - Fax:812-206-1213
Practice Address - Street 1:460 SPRING ST.
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130
Practice Address - Country:US
Practice Address - Phone:812-280-2080
Practice Address - Fax:812-206-1213
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4022104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker