Provider Demographics
NPI:1396140125
Name:HICKS, MELISSA ANN (MS, CGC)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANN
Last Name:HICKS
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:DUMOUCHELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3980 JOHN R ST
Mailing Address - Street 2:4 WEBBER NORTH, BOX 160
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2018
Mailing Address - Country:US
Mailing Address - Phone:313-993-4433
Mailing Address - Fax:313-993-4444
Practice Address - Street 1:3980 JOHN R ST
Practice Address - Street 2:4 WEBBER NORTH, BOX 160
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2018
Practice Address - Country:US
Practice Address - Phone:313-993-4433
Practice Address - Fax:313-993-4444
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS