Healthcare Provider Details

I. General information

NPI: 1700727914
Provider Name (Legal Business Name): JUSTIN TAYLOR HICKS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7004 SECURITY BLVD
WINDSOR MILL MD
21244-2557
US

IV. Provider business mailing address

7004 SECURITY BLVD STE 300-A36
WINDSOR MILL MD
21244-2557
US

V. Phone/Fax

Practice location:
  • Phone: 443-591-9884
  • Fax:
Mailing address:
  • Phone: 443-591-9884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number31719
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: