Provider Demographics
NPI:1659589398
Name:BICKHAM, PAULA (PHD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:BICKHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LEON SULLIVAN WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-2402
Mailing Address - Country:US
Mailing Address - Phone:304-346-9689
Mailing Address - Fax:304-345-4601
Practice Address - Street 1:16 LEON SULLIVAN WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2402
Practice Address - Country:US
Practice Address - Phone:304-346-9689
Practice Address - Fax:304-345-4601
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV882103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1891826707OtherTYPE 2 NPI NUMBER