Provider Demographics
NPI:1215600846
Name:HICKS, MAYGEN MARIE (LCSWA)
Entity Type:Individual
Prefix:
First Name:MAYGEN
Middle Name:MARIE
Last Name:HICKS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 CATARINA LN
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-7043
Mailing Address - Country:US
Mailing Address - Phone:804-385-6160
Mailing Address - Fax:
Practice Address - Street 1:3123 CATARINA LN
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-7043
Practice Address - Country:US
Practice Address - Phone:804-385-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer