Healthcare Provider Details

I. General information

NPI: 1568502888
Provider Name (Legal Business Name): JOSEPH B. HICKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S GOVERNORS AVE
DOVER DE
19904-7020
US

IV. Provider business mailing address

1550 S GOVERNORS AVE
DOVER DE
19904-7020
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-4558
  • Fax: 302-678-4577
Mailing address:
  • Phone: 302-678-4558
  • Fax: 302-678-4577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0000043
License Number StateDE

VIII. Authorized Official

Name: MR. JOSEPH B HICKS
Title or Position: OWNER
Credential: LPCMH, CCMHC
Phone: 302-436-5868