Provider Demographics
NPI:1710270723
Name:THOMAS, ALLISON FAITH HICKS
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:FAITH HICKS
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:FAITH
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 N CHERRY ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2939
Mailing Address - Country:US
Mailing Address - Phone:336-748-4038
Mailing Address - Fax:336-748-4108
Practice Address - Street 1:601 N CHERRY ST
Practice Address - Street 2:SUITE 300
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2939
Practice Address - Country:US
Practice Address - Phone:336-748-4038
Practice Address - Fax:336-748-4108
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0049081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical