Provider Demographics
NPI:1336139302
Name:HICKS, BEVERLY JUNE (MD, LPC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JUNE
Last Name:HICKS
Suffix:
Gender:F
Credentials:MD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 PAVERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4708
Mailing Address - Country:US
Mailing Address - Phone:919-847-2197
Mailing Address - Fax:919-846-7748
Practice Address - Street 1:901 PAVERSTONE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4710
Practice Address - Country:US
Practice Address - Phone:919-847-2197
Practice Address - Fax:919-846-7748
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3377101YA0400X
NC2874101YP2500X
NC003662-042571106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist