Provider Demographics
NPI:1508619529
Name:HICKS, GARY LEHN (LPC-S)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LEHN
Last Name:HICKS
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6808 SELLERS RD
Mailing Address - Street 2:
Mailing Address - City:DORA
Mailing Address - State:AL
Mailing Address - Zip Code:35062-2406
Mailing Address - Country:US
Mailing Address - Phone:057-170-2682
Mailing Address - Fax:
Practice Address - Street 1:1816 CHILDHAVEN RD NE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5902
Practice Address - Country:US
Practice Address - Phone:256-734-6720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC03785101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional