Provider Demographics
NPI:1164895579
Name:HICKS, LAUREL M (LMSW)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:M
Last Name:HICKS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40476 VILLAGE WOOD RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-4561
Mailing Address - Country:US
Mailing Address - Phone:313-405-9642
Mailing Address - Fax:
Practice Address - Street 1:40476 VILLAGE WOOD RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-4561
Practice Address - Country:US
Practice Address - Phone:313-405-9642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010942771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical