Provider Demographics
NPI:1851471395
Name:HICKS, JOSEPH B (CCMHC, LPCMH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:B
Last Name:HICKS
Suffix:
Gender:M
Credentials:CCMHC, LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33124 LIGHTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-4018
Mailing Address - Country:US
Mailing Address - Phone:302-436-5868
Mailing Address - Fax:302-436-2035
Practice Address - Street 1:33124 LIGHTHOUSE RD
Practice Address - Street 2:
Practice Address - City:SELBYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19975-4018
Practice Address - Country:US
Practice Address - Phone:302-436-5868
Practice Address - Fax:302-436-2035
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0000043101YM0800X
DEPC-0000043101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000022268Medicaid