Provider Demographics
NPI:1952042590
Name:HICKSON, EDNA CARTER (LISW-CP)
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:CARTER
Last Name:HICKSON
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3178 PLAYER CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-8351
Mailing Address - Country:US
Mailing Address - Phone:912-281-7846
Mailing Address - Fax:
Practice Address - Street 1:3178 PLAYER CT
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-8351
Practice Address - Country:US
Practice Address - Phone:912-281-7846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC175191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical