Provider Demographics
NPI:1295109973
Name:HICKS, TERA LYNN (LPCC)
Entity type:Individual
Prefix:MRS
First Name:TERA
Middle Name:LYNN
Last Name:HICKS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ASHLAND DR STE 301
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7097
Mailing Address - Country:US
Mailing Address - Phone:606-326-0322
Mailing Address - Fax:606-326-9809
Practice Address - Street 1:1000 ASHLAND DR STE 301
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7097
Practice Address - Country:US
Practice Address - Phone:606-326-0322
Practice Address - Fax:606-326-9809
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY245080101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional