MEDICARE: GLENDA R HICKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1659265411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENDA R HICKS

Provider Business Mailing Address
First Line	:	214 DARGUN RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21221-4012
Country	:	US
Telephone Number	:	443-562-6417
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 DARGUN RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21221-4012
Country	:	US
Telephone Number	:	443-562-6417
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2025
Last Update Date	:	06/05/2025

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Directions to “ GLENDA R HICKS ” Practice Location

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