Provider Demographics
NPI:1275617151
Name:HICKS, SARAH ELIZABETH (MA)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ELIZABETH
Last Name:HICKS
Suffix:
Gender:F
Credentials:MA
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 9305
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-0305
Mailing Address - Country:US
Mailing Address - Phone:304-767-7825
Mailing Address - Fax:304-767-7829
Practice Address - Street 1:4607 MACCORKLE AVE SW
Practice Address - Street 2:SUITE 305
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1364
Practice Address - Country:US
Practice Address - Phone:304-767-7825
Practice Address - Fax:304-767-7829
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV940103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist