Provider Demographics
NPI:1487015178
Name:HICKS, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
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 1:7104 62ND AVENUE CT W
Mailing Address - Street 2:APT. D
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8177
Mailing Address - Country:US
Mailing Address - Phone:480-532-4692
Mailing Address - Fax:
Practice Address - Street 1:610 YAKIMA AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4851
Practice Address - Country:US
Practice Address - Phone:253-396-5230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor