Healthcare Provider Details

I. General information

NPI: 1205632338
Provider Name (Legal Business Name): SELENA HICKS MA, ATR-BC, ITR-CTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 STUART CIR UNIT 300B
RICHMOND VA
23220-3754
US

IV. Provider business mailing address

413 STUART CIR UNIT 300B
RICHMOND VA
23220-3754
US

V. Phone/Fax

Practice location:
  • Phone: 804-445-8862
  • Fax:
Mailing address:
  • Phone: 757-814-0218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: