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NPI Code Detail

MEDICARE: CHANDRA HICKS LMHC

MEDICARE: CHANDRA HICKS LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorMH16230FL
2106H00000XMarriage & Family TherapistIMH 13057FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386023950
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANDRA HICKS LMHC
Provider Business Mailing Address
First Line : 10752 DEERWOOD PARK BLVD STE 100
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-4846
Country : US
Telephone Number : 904-834-1124
Fax Number :
Provider Business Practice Location Address
First Line : 10752 DEERWOOD PARK BLVD STE 100
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-4846
Country : US
Telephone Number : 904-834-1124
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2015
Last Update Date : 11/21/2025

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Directions to “ CHANDRA HICKS LMHC” Practice Location

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