Provider Demographics
NPI:1306313713
Name:HICKMAN, CLAIRE (CDP)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:CDP
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 257 PMB 6001
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9601 BUJACICH RD NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-8300
Practice Address - Country:US
Practice Address - Phone:253-858-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2020-08-07
Deactivation Date:2019-07-31
Deactivation Code:
Reactivation Date:2020-08-07
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
WACP60815839101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)