Provider Demographics
NPI:1790437085
Name:HICKS, EBONY (BT)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4445
Mailing Address - Country:US
Mailing Address - Phone:240-487-6946
Mailing Address - Fax:
Practice Address - Street 1:4600 POWDER MILL RD STE 250
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2688
Practice Address - Country:US
Practice Address - Phone:301-327-5199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician