Provider Demographics
NPI:1467804195
Name:LE BLANC HICKS, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:LE BLANC 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 1:1404 S VIENNA ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-6428
Mailing Address - Country:US
Mailing Address - Phone:318-224-9200
Mailing Address - Fax:318-224-9201
Practice Address - Street 1:1404 S VIENNA ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-6428
Practice Address - Country:US
Practice Address - Phone:318-224-9200
Practice Address - Fax:318-224-9201
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health