Provider Demographics
NPI:1033580881
Name:HICKS, DIA DANAE (LPC CADC)
Entity Type:Individual
Prefix:
First Name:DIA
Middle Name:DANAE
Last Name:HICKS
Suffix:
Gender:F
Credentials:LPC CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9378 OLIVE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3223
Mailing Address - Country:US
Mailing Address - Phone:314-730-0083
Mailing Address - Fax:612-241-2552
Practice Address - Street 1:9378 OLIVE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-3223
Practice Address - Country:US
Practice Address - Phone:314-730-0083
Practice Address - Fax:612-241-2552
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6614101YA0400X
MO2014008242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)