Provider Demographics
NPI:1215502893
Name:HICKMON, JILL D
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:D
Last Name:HICKMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 MAMIE ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1735
Mailing Address - Country:US
Mailing Address - Phone:601-705-1906
Mailing Address - Fax:601-705-1952
Practice Address - Street 1:91180 HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:RICHTON
Practice Address - State:MS
Practice Address - Zip Code:39476-9254
Practice Address - Country:US
Practice Address - Phone:601-788-6308
Practice Address - Fax:601-788-6349
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor