Healthcare Provider Details

I. General information

NPI: 1851471395
Provider Name (Legal Business Name): JOSEPH B HICKS CCMHC, LPCMH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33124 LIGHTHOUSE RD
SELBYVILLE DE
19975-4018
US

IV. Provider business mailing address

33124 LIGHTHOUSE RD
SELBYVILLE DE
19975-4018
US

V. Phone/Fax

Practice location:
  • Phone: 302-436-5868
  • Fax: 302-436-2035
Mailing address:
  • Phone: 302-436-5868
  • Fax: 302-436-2035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0000043
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC-0000043
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: