Provider Demographics
NPI:1144650821
Name:RICKMAN, PATRICIA MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MARIE
Last Name:RICKMAN
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 1:310 PAPER TRAIL WAY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-5203
Mailing Address - Country:US
Mailing Address - Phone:678-880-4645
Mailing Address - Fax:770-628-0046
Practice Address - Street 1:310 PAPER TRAIL WAY
Practice Address - Street 2:SUITE 106
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-5203
Practice Address - Country:US
Practice Address - Phone:678-880-4645
Practice Address - Fax:770-628-0046
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0036781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical