Healthcare Provider Details

I. General information

NPI: 1588790703
Provider Name (Legal Business Name): MR. BERNARD NORRIS HICKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 DE LA VINA ST
SANTA BARBARA CA
93105-3814
US

IV. Provider business mailing address

2034 DE LA VINA ST
SANTA BARBARA CA
93105-3814
US

V. Phone/Fax

Practice location:
  • Phone: 805-319-9562
  • Fax:
Mailing address:
  • Phone: 805-319-9562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: