Provider Demographics
NPI:1881994572
Name:RICKMAN, MICA NICOLE (MA,EDS)
Entity type:Individual
Prefix:
First Name:MICA
Middle Name:NICOLE
Last Name:RICKMAN
Suffix:
Gender:F
Credentials:MA,EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 NEW HOPE DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-7458
Mailing Address - Country:US
Mailing Address - Phone:662-286-7199
Mailing Address - Fax:662-286-8908
Practice Address - Street 1:401 NEW HOPE DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-7458
Practice Address - Country:US
Practice Address - Phone:662-286-7199
Practice Address - Fax:662-286-8908
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2760101YP2500X
TN2654101YM0800X
MS1772101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health