Provider Demographics
NPI:1699286120
Name:BICKHAM, DWAN ZENON (LCSW)
Entity type:Individual
Prefix:
First Name:DWAN
Middle Name:ZENON
Last Name:BICKHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6814 SILVER SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-4037
Mailing Address - Country:US
Mailing Address - Phone:225-335-7703
Mailing Address - Fax:
Practice Address - Street 1:6814 SILVER SPRINGS DR.
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739
Practice Address - Country:US
Practice Address - Phone:225-335-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA109551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical