Provider Demographics
NPI:1992809909
Name:HICKMAN, BLAIR HAREN (MSSW LCSW)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:HAREN
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:MSSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 W OAKLAND AVE
Mailing Address - Street 2:SUITE 226
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1445
Mailing Address - Country:US
Mailing Address - Phone:423-262-0317
Mailing Address - Fax:423-262-0311
Practice Address - Street 1:926 W OAKLAND AVE
Practice Address - Street 2:SUITE 226
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1445
Practice Address - Country:US
Practice Address - Phone:423-262-0317
Practice Address - Fax:423-262-0311
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW3260104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
1047231OtherCIGNA-MCC
100676OtherUBH-HEALTHPLAN
3697987OtherMEDICARE-TN
3085266OtherMAGELLAN SUMMIT
351654200OtherDOL WORKERS COMP