Provider Demographics
NPI:1821464546
Name:HICKS, KHRISHANDALYN RATIONNE (LCSW)
Entity Type:Individual
Prefix:DR
First Name:KHRISHANDALYN
Middle Name:RATIONNE
Last Name:HICKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 KELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4804
Mailing Address - Country:US
Mailing Address - Phone:225-239-5498
Mailing Address - Fax:225-239-5543
Practice Address - Street 1:524 S BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-3448
Practice Address - Country:US
Practice Address - Phone:225-257-4677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA89231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical