Provider Demographics
NPI:1457990400
Name:HICKS, ANDREW G (MS, CADC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:G
Last Name:HICKS
Suffix:
Gender:M
Credentials:MS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 E BARNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1708
Mailing Address - Country:US
Mailing Address - Phone:231-725-8316
Mailing Address - Fax:
Practice Address - Street 1:985 E BARNEY AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1708
Practice Address - Country:US
Practice Address - Phone:231-725-8316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-21
Last Update Date:2019-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI02-1292101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI12-0292OtherMICHIGAN CERTIFICATION BOARD FOR ADDICTION PROFESSIONALS