Provider Demographics
NPI:1255560199
Name:HICKCOX, ROBERTA A (CAC)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:A
Last Name:HICKCOX
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-2100
Mailing Address - Country:US
Mailing Address - Phone:717-632-4900
Mailing Address - Fax:717-334-9114
Practice Address - Street 1:44 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2100
Practice Address - Country:US
Practice Address - Phone:717-632-4900
Practice Address - Fax:717-334-9114
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3048101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)