Provider Demographics
NPI:1497986913
Name:HICKS, BETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 WELBY WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4473
Mailing Address - Country:US
Mailing Address - Phone:850-212-3404
Mailing Address - Fax:888-866-4926
Practice Address - Street 1:5833 COUNTRYSIDE DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-1453
Practice Address - Country:US
Practice Address - Phone:850-212-3404
Practice Address - Fax:888-866-4926
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 94801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1204Medicaid