Provider Demographics
NPI:1205632338
Name:HICKS, SELENA (MA, ATR-BC, ITR-CTS)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:HICKS
Suffix:
Gender:
Credentials:MA, ATR-BC, ITR-CTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 STUART CIR UNIT 300B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-3754
Mailing Address - Country:US
Mailing Address - Phone:757-814-0218
Mailing Address - Fax:
Practice Address - Street 1:413 STUART CIR UNIT 300B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-3754
Practice Address - Country:US
Practice Address - Phone:804-445-8862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist