Provider Demographics
NPI:1609460476
Name:YOUNG HICKS, LAKIESHA (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:MRS
First Name:LAKIESHA
Middle Name:
Last Name:YOUNG HICKS
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3741 LEE ROAD 393
Mailing Address - Street 2:
Mailing Address - City:NOTASULGA
Mailing Address - State:AL
Mailing Address - Zip Code:36866-2104
Mailing Address - Country:US
Mailing Address - Phone:334-332-2150
Mailing Address - Fax:
Practice Address - Street 1:209 SAMFORD AVE
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-3121
Practice Address - Country:US
Practice Address - Phone:334-332-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty