Provider Demographics
NPI:1770029357
Name:HICKS, LACY (LPC)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 KELLY ST
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-2611
Mailing Address - Country:US
Mailing Address - Phone:912-659-5866
Mailing Address - Fax:
Practice Address - Street 1:129 KELLY ST
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-2611
Practice Address - Country:US
Practice Address - Phone:912-659-5866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008360101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor