MEDICARE: TERRANCE 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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1790673309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRANCE HICKS

Provider Business Mailing Address
First Line	:	18110 FAIRFIELD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-3705
Country	:	US
Telephone Number	:	248-785-7334
Fax Number	:

Provider Business Practice Location Address
First Line	:	12260 CAMDEN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48213-1756
Country	:	US
Telephone Number	:	248-785-7334
Fax Number	:

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

Provider Enumeration Date	:	06/24/2025
Last Update Date	:	06/24/2025

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Directions to “ TERRANCE HICKS ” Practice Location

Language	Start Address	Practice Location

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