Provider Demographics
NPI:1992010441
Name:HICKS, MARY ZUNIGA (LMSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ZUNIGA
Last Name:HICKS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:STEPHANI
Other - Last Name:ZUNIGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1815 PLEASANT GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-7870
Mailing Address - Country:US
Mailing Address - Phone:870-933-6886
Mailing Address - Fax:870-933-9395
Practice Address - Street 1:75 HWY 62/412
Practice Address - Street 2:SUITE J
Practice Address - City:ASH FLAT
Practice Address - State:AR
Practice Address - Zip Code:72513-9626
Practice Address - Country:US
Practice Address - Phone:870-994-7060
Practice Address - Fax:870-994-7063
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9533-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker