Provider Demographics
NPI:1790446573
Name:HICKS, SANDRA (LCASA)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 S BECKFORD DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-5908
Mailing Address - Country:US
Mailing Address - Phone:252-767-9323
Mailing Address - Fax:
Practice Address - Street 1:943 W ANDREWS AVE STE H
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2562
Practice Address - Country:US
Practice Address - Phone:252-433-0611
Practice Address - Fax:252-433-0065
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-26330101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)