Healthcare Provider Details

I. General information

NPI: 1811831100
Provider Name (Legal Business Name): JONATHAN HICKS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 WHARTON LN NE
NORTON VA
24273-1541
US

IV. Provider business mailing address

1167 SPRATLIN PARK DR
GRAY TN
37615-6205
US

V. Phone/Fax

Practice location:
  • Phone: 276-260-9991
  • Fax: 276-260-9717
Mailing address:
  • Phone: 423-467-3600
  • Fax: 423-467-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016100
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: