Provider Demographics
NPI:1013254317
Name:HICKS, GERIMAR DEON
Entity Type:Individual
Prefix:
First Name:GERIMAR
Middle Name:DEON
Last Name:HICKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 HASSELL AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-3541
Mailing Address - Country:US
Mailing Address - Phone:702-205-7638
Mailing Address - Fax:
Practice Address - Street 1:2024 HASSELL AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-3541
Practice Address - Country:US
Practice Address - Phone:702-205-7638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health