Doctor Name: | MRS. TERA LYNN HICKS |
NPI Number: | 1295109973 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NCC, LPCA |
License Number: | LPCCCA00218242 |
Business Practice Address: | 125 S Main Cross St Louisa, KY - 412301065 |
Business Phone Number: | 6066380938 |
Business Fax Number: | |
Mailing Address: | Po Box 726, LOUISA |
State: | KY |
Postal Code: | 412300726 |
Phone Number: | 6066380938 |
Fax Number: | |
NPI Enumeration Date: | 11/18/2015 |
NPI Last Update Date: | 11/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LPCCCA00218242 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |