Provider Demographics
NPI:1093559189
Name:HICKMAN, STEVEN A SR (CHC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:HICKMAN
Suffix:SR
Gender:M
Credentials:CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1334
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23439-1334
Mailing Address - Country:US
Mailing Address - Phone:346-404-1332
Mailing Address - Fax:
Practice Address - Street 1:445 N MAIN ST UNIT 1334
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23439-1529
Practice Address - Country:US
Practice Address - Phone:346-404-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No175T00000XOther Service ProvidersPeer Specialist