Provider Demographics
NPI:1922659671
Name:HICKMAN, MARY (MS, CGC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S BERETANIA ST STE 950
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1874
Mailing Address - Country:US
Mailing Address - Phone:808-373-7555
Mailing Address - Fax:808-373-7599
Practice Address - Street 1:1401 S BERETANIA ST STE 950
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1874
Practice Address - Country:US
Practice Address - Phone:808-373-7555
Practice Address - Fax:847-723-8675
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS