Provider Demographics
NPI:1255074993
Name:HICKS, JOSEPH MAURICE SR (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MAURICE
Last Name:HICKS
Suffix:SR
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-0074
Mailing Address - Country:US
Mailing Address - Phone:948-867-3889
Mailing Address - Fax:
Practice Address - Street 1:305 MARSH VIEW CT
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:VA
Practice Address - Zip Code:23314-2243
Practice Address - Country:US
Practice Address - Phone:808-372-9615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184166163WP0807X, 163WP0808X, 364SP0811X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No364SP0811XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Chronically IllGroup - Multi-Specialty