| Doctor Name: | DIA DANAE HICKS |
| NPI Number: | 1033580881 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC CADC |
| License Number: | 6614 |
| Business Practice Address: | 3 N Delaware Ave Belleville, IL - 622215404 |
| Business Phone Number: | 3144486367 |
| Business Fax Number: | |
| Mailing Address: | 3 N Delaware Ave, BELLEVILLE |
| State: | IL |
| Postal Code: | 622215404 |
| Phone Number: | 3144486367 |
| Fax Number: | |
| NPI Enumeration Date: | 10/19/2015 |
| NPI Last Update Date: | 10/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 6614 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |