Provider Demographics
NPI:1942925441
Name:HICKS, TAYLOR JAMES ROBERT (CADC II, CRPS)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JAMES ROBERT
Last Name:HICKS
Suffix:
Gender:M
Credentials:CADC II, CRPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 ROCKLIN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2708
Mailing Address - Country:US
Mailing Address - Phone:916-234-0097
Mailing Address - Fax:
Practice Address - Street 1:3900 ROCKLIN RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2708
Practice Address - Country:US
Practice Address - Phone:916-234-0097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARACPS9941120405300000X
CARA9931120101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARACPS9941120OtherCALIFORNIA CONSORTIUM OF ADDICTION PROFESSIONALS
CARA9931120OtherCALIFORNIA CONSORTIUM OF ADDICTION PROFESSIONALS