Provider Demographics
NPI:1437725736
Name:HICKS, SHATONIA MONIQUE
Entity Type:Individual
Prefix:MRS
First Name:SHATONIA
Middle Name:MONIQUE
Last Name: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 1:899 OLD CLUBHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-3082
Mailing Address - Country:US
Mailing Address - Phone:757-701-6444
Mailing Address - Fax:
Practice Address - Street 1:1130 TABB ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3434
Practice Address - Country:US
Practice Address - Phone:757-625-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060112781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical