Provider Demographics
NPI:1639315534
Name:HICKMAN, JONATHAN TODD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:TODD
Last Name:HICKMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 WALNUT GROVE RD
Mailing Address - Street 2:STE. 2
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-2714
Mailing Address - Country:US
Mailing Address - Phone:901-870-4891
Mailing Address - Fax:901-458-9522
Practice Address - Street 1:2924 WALNUT GROVE RD
Practice Address - Street 2:STE. 2
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-2714
Practice Address - Country:US
Practice Address - Phone:901-870-4891
Practice Address - Fax:901-458-9522
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical