Provider Demographics
NPI:1003130535
Name:HICKS, DAVID MERRITT (CO60131166)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MERRITT
Last Name:HICKS
Suffix:
Gender:M
Credentials:CO60131166
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18442
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-0442
Mailing Address - Country:US
Mailing Address - Phone:206-941-9925
Mailing Address - Fax:
Practice Address - Street 1:2610 WETMORE AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2927
Practice Address - Country:US
Practice Address - Phone:425-258-5270
Practice Address - Fax:425-258-5275
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YAO400X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)