Provider Demographics
NPI:1578116083
Name:HICKMAN, CLIFF JAMES (BCBA)
Entity Type:Individual
Prefix:
First Name:CLIFF
Middle Name:JAMES
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 KOKOMO RD STE 206
Mailing Address - Street 2:
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-5072
Mailing Address - Country:US
Mailing Address - Phone:808-214-2326
Mailing Address - Fax:815-301-8942
Practice Address - Street 1:810 HAIKU RD STE 244
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-4801
Practice Address - Country:US
Practice Address - Phone:808-214-2326
Practice Address - Fax:815-301-8942
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-04-1504103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst