Provider Demographics
NPI:1568912673
Name:HICKMAN, LAUREN MARIE
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MARIE
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:BAUGHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ICADC
Mailing Address - Street 1:1903 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GLASSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15045-1233
Mailing Address - Country:US
Mailing Address - Phone:610-730-4967
Mailing Address - Fax:
Practice Address - Street 1:1903 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GLASSPORT
Practice Address - State:PA
Practice Address - Zip Code:15045-1233
Practice Address - Country:US
Practice Address - Phone:610-730-4967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9099101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor