Healthcare Provider Details

I. General information

NPI: 1134739956
Provider Name (Legal Business Name): NICOLE HICKS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 SAUNDERS RD
LYNN MA
01904-1571
US

IV. Provider business mailing address

28 SAUNDERS RD
LYNN MA
01904-1571
US

V. Phone/Fax

Practice location:
  • Phone: 781-264-3859
  • Fax:
Mailing address:
  • Phone: 781-264-3859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE HICKS
Title or Position: OWNER
Credential: LMHC
Phone: 781-264-3859