Provider Demographics
NPI:1114398781
Name:HICKS, NASTASHIA
Entity Type:Individual
Prefix:
First Name:NASTASHIA
Middle Name:
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:PO BOX 872
Mailing Address - Street 2:
Mailing Address - City:MARINGOUIN
Mailing Address - State:LA
Mailing Address - Zip Code:70757-0872
Mailing Address - Country:US
Mailing Address - Phone:225-262-9166
Mailing Address - Fax:
Practice Address - Street 1:120 N CAROLINA ST
Practice Address - Street 2:
Practice Address - City:NEW ROADS
Practice Address - State:LA
Practice Address - Zip Code:70760-3604
Practice Address - Country:US
Practice Address - Phone:225-638-8449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health