Provider Demographics
NPI:1083247639
Name:HICKS, ERICA C
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:C
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 COLBURN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507-6647
Mailing Address - Country:US
Mailing Address - Phone:774-922-0105
Mailing Address - Fax:
Practice Address - Street 1:112 COLBURN RD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-6647
Practice Address - Country:US
Practice Address - Phone:774-922-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician