1245849603 NPI number — ALICIA C HICKS LPCMH

Table of content: ALICIA C HICKS LPCMH (NPI 1245849603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245849603 NPI number — ALICIA C HICKS LPCMH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HICKS
Provider First Name:
ALICIA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCMH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245849603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
122 FEDERAL WALK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNETT SQUARE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19348-1866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-288-0078
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2145 GRAVES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOCKESSIN
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19707-9129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-734-0277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  PC-0000990 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PC-0000990 . This is a "PROFESSIONAL COUNSELOR OF MENTAL HEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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