Provider Demographics
NPI:1679881569
Name:HICKMAN, LEIA MAE
Entity Type:Individual
Prefix:MS
First Name:LEIA
Middle Name:MAE
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 HARVEST DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6371
Mailing Address - Country:US
Mailing Address - Phone:617-620-8784
Mailing Address - Fax:978-208-7021
Practice Address - Street 1:3105 HARVEST DR
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-6371
Practice Address - Country:US
Practice Address - Phone:617-620-8784
Practice Address - Fax:978-208-7021
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor