Provider Demographics
NPI:1972855625
Name:HICKS, RAIESHA AMYELA (CRT, HHA)
Entity Type:Individual
Prefix:
First Name:RAIESHA
Middle Name:AMYELA
Last Name:HICKS
Suffix:
Gender:F
Credentials:CRT, HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 13TH PL SE APT 303
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-5031
Mailing Address - Country:US
Mailing Address - Phone:202-340-1357
Mailing Address - Fax:
Practice Address - Street 1:2020 SAVANNAH PL SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020
Practice Address - Country:US
Practice Address - Phone:202-340-1357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1452728374U00000X, 2278H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide