Provider Demographics
NPI:1982061149
Name:HICKMAN, OLIVIA (LMHC)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:AYERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:604 LAFAYETTE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-4708
Mailing Address - Country:US
Mailing Address - Phone:319-859-7715
Mailing Address - Fax:515-220-2272
Practice Address - Street 1:604 LAFAYETTE ST FL 2
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-4708
Practice Address - Country:US
Practice Address - Phone:319-859-7715
Practice Address - Fax:515-220-2272
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IA098682101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor