Provider Demographics
NPI:1568931327
Name:HICKMAN, CHRISTOPHER EDWARDS (PRIMARY THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:EDWARDS
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:PRIMARY THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 LAKE POINTE DR APT 201
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3583
Mailing Address - Country:US
Mailing Address - Phone:954-901-9317
Mailing Address - Fax:
Practice Address - Street 1:218 LAKE POINTE DR APT 201
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-3583
Practice Address - Country:US
Practice Address - Phone:954-901-9317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH15347101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health