Provider Demographics
NPI:1285875898
Name:HICKERSON, GERALDINE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:
Last Name:HICKERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:GERALDINE
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:611 PEACEFUL DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-6465
Mailing Address - Country:US
Mailing Address - Phone:270-317-2880
Mailing Address - Fax:
Practice Address - Street 1:1239 WOODLAND DR STE 110
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-3723
Practice Address - Country:US
Practice Address - Phone:270-312-9655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY33941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY 3394OtherLCSW