Provider Demographics
NPI:1417726464
Name:HICKS, LAMONT TERRANCE JR
Entity Type:Individual
Prefix:
First Name:LAMONT
Middle Name:TERRANCE
Last Name:HICKS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8835 TERRY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-2341
Mailing Address - Country:US
Mailing Address - Phone:313-377-1018
Mailing Address - Fax:
Practice Address - Street 1:8835 TERRY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-2341
Practice Address - Country:US
Practice Address - Phone:313-377-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist