Provider Demographics
NPI:1346619152
Name:JAMES-HICKS, KESHIA TAMARA
Entity Type:Individual
Prefix:MRS
First Name:KESHIA
Middle Name:TAMARA
Last Name:JAMES-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 1:12147 COURSEY BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4410
Mailing Address - Country:US
Mailing Address - Phone:225-771-8149
Mailing Address - Fax:225-771-8876
Practice Address - Street 1:12147 COURSEY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4410
Practice Address - Country:US
Practice Address - Phone:225-771-8149
Practice Address - Fax:225-771-8876
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional