Provider Demographics
NPI:1841806924
Name:HICKS, DANNY RAY JR (LSW, LADC)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:RAY
Last Name:HICKS
Suffix:JR
Gender:M
Credentials:LSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2603
Mailing Address - Country:US
Mailing Address - Phone:651-734-8307
Mailing Address - Fax:
Practice Address - Street 1:170 9TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2603
Practice Address - Country:US
Practice Address - Phone:651-734-8307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11235101YP2500X
MN305802101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)