Provider Demographics
NPI:1013352574
Name:HICKS, DENESSA (CD)
Entity Type:Individual
Prefix:
First Name:DENESSA
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2742 EUSTON CT
Mailing Address - Street 2:
Mailing Address - City:BRYANS ROAD
Mailing Address - State:MD
Mailing Address - Zip Code:20616-7006
Mailing Address - Country:US
Mailing Address - Phone:571-377-0806
Mailing Address - Fax:
Practice Address - Street 1:2742 EUSTON CT
Practice Address - Street 2:
Practice Address - City:BRYANS ROAD
Practice Address - State:MD
Practice Address - Zip Code:20616-7006
Practice Address - Country:US
Practice Address - Phone:571-377-0806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula