Provider Demographics
NPI:1841711462
Name:HICKS, MARY (MBA, CADC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:MBA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 WOODS RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7247
Mailing Address - Country:US
Mailing Address - Phone:502-612-2252
Mailing Address - Fax:
Practice Address - Street 1:305 WOODS RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7247
Practice Address - Country:US
Practice Address - Phone:502-612-2252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
165492101YA0400X
KY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)