Provider Demographics
NPI:1851611404
Name:HICKMAN, TRACY ELAINE (CRC, LPC, LCAS)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ELAINE
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:CRC, LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 E WT HARRIS BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-3541
Mailing Address - Country:US
Mailing Address - Phone:704-566-3410
Mailing Address - Fax:704-537-1226
Practice Address - Street 1:5820 E WT HARRIS BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3541
Practice Address - Country:US
Practice Address - Phone:704-566-3410
Practice Address - Fax:704-537-1226
Is Sole Proprietor?:No
Enumeration Date:2010-06-06
Last Update Date:2010-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1583101YA0400X
NC3194101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)