Provider Demographics
NPI:1629141908
Name:HICKS, ROBERT ALAN (MSW, LISAC, BHP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALAN
Last Name:HICKS
Suffix:
Gender:M
Credentials:MSW, LISAC, BHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-3725
Mailing Address - Country:US
Mailing Address - Phone:928-639-4440
Mailing Address - Fax:928-639-3924
Practice Address - Street 1:636 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3725
Practice Address - Country:US
Practice Address - Phone:928-639-4440
Practice Address - Fax:928-639-3924
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11456104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker