Provider Demographics
NPI:1972315836
Name:BICKHAM, SIERRA N
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:N
Last Name:BICKHAM
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 1:11885 FAIRWAY OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-6678
Mailing Address - Country:US
Mailing Address - Phone:845-372-3473
Mailing Address - Fax:
Practice Address - Street 1:11885 FAIRWAY OVERLOOK
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-6678
Practice Address - Country:US
Practice Address - Phone:845-372-3473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician