Provider Demographics
NPI:1356739494
Name:HICKS, CICELY SIMONE (MHPP HOT SPRINGS)
Entity type:Individual
Prefix:MRS
First Name:CICELY
Middle Name:SIMONE
Last Name:HICKS
Suffix:
Gender:F
Credentials:MHPP HOT SPRINGS
Other - Prefix:MS
Other - First Name:CICELY
Other - Middle Name:SIMONE
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10025 W. MARKHAM ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-663-5473
Mailing Address - Fax:501-801-1816
Practice Address - Street 1:3604 CENTRAL AVE
Practice Address - Street 2:SUITE C
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:501-623-9220
Practice Address - Fax:501-801-1816
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator