Provider Demographics
NPI:1659737880
Name:LAUREL HICKS, LCSW, LLC
Entity Type:Organization
Organization Name:LAUREL HICKS, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:317-966-8366
Mailing Address - Street 1:5704 MUSTANG TER
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-8413
Mailing Address - Country:US
Mailing Address - Phone:317-966-8366
Mailing Address - Fax:317-837-4901
Practice Address - Street 1:2680 E MAIN ST
Practice Address - Street 2:SUITE 126
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2825
Practice Address - Country:US
Practice Address - Phone:317-966-8366
Practice Address - Fax:317-837-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004687A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty