Provider Demographics
NPI:1356528715
Name:HICKMAN, ANDREA B (MED, LMHC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:B
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:BERNICE
Other - Last Name:CLOUTIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:4510 PICKEREL CIR NW
Mailing Address - Street 2:APARTMENT A
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98315-9765
Mailing Address - Country:US
Mailing Address - Phone:503-329-8633
Mailing Address - Fax:
Practice Address - Street 1:20174 FRONT ST NE
Practice Address - Street 2:C/O FRONT STREET CLINIC
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7445
Practice Address - Country:US
Practice Address - Phone:503-329-8633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health