Provider Demographics
NPI:1790430700
Name:HICKS, KARA MARIE (MI)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:MARIE
Last Name:HICKS
Suffix:
Gender:F
Credentials:MI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6167 STERLING DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48166-9647
Mailing Address - Country:US
Mailing Address - Phone:734-925-2483
Mailing Address - Fax:
Practice Address - Street 1:1401 ASH ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2999
Practice Address - Country:US
Practice Address - Phone:313-557-8717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803085699104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker