Healthcare Provider Details

I. General information

NPI: 1639897796
Provider Name (Legal Business Name): ROBIN MARANDA HICKS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN MARANDA WILLIAMS ROBIN HICKS MA, LPCC

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 YORK AVE S STE 417
EDINA MN
55435-2336
US

IV. Provider business mailing address

4536 58TH AVE N APT 239
BROOKLYN CENTER MN
55429-2994
US

V. Phone/Fax

Practice location:
  • Phone: 952-426-3034
  • Fax: 612-801-7177
Mailing address:
  • Phone: 520-987-3196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3455
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: