Provider Demographics
NPI:1265604235
Name:HICKS, LISA MARIE (LAC, DIPLAC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:HICKS
Suffix:
Gender:F
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:138 HILLVIEW CT
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:OH
Mailing Address - Zip Code:43056-5517
Mailing Address - Country:US
Mailing Address - Phone:740-334-0485
Mailing Address - Fax:740-522-0228
Practice Address - Street 1:225 S 21ST ST STE C
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3875
Practice Address - Country:US
Practice Address - Phone:740-334-0485
Practice Address - Fax:740-522-0228
Is Sole Proprietor?:No
Enumeration Date:2008-03-30
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000155171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist