Provider Demographics
NPI:1457990400
Name:HICKS, ANDREW G (MS, MA, LLP, CADC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:G
Last Name:HICKS
Suffix:
Gender:M
Credentials:MS, MA, LLP, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:WEST OLIVE
Mailing Address - State:MI
Mailing Address - Zip Code:49460-0175
Mailing Address - Country:US
Mailing Address - Phone:231-215-8976
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 175
Practice Address - Street 2:
Practice Address - City:WEST OLIVE
Practice Address - State:MI
Practice Address - Zip Code:49460-0175
Practice Address - Country:US
Practice Address - Phone:231-215-8976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-21
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI02-1292101YA0400X
MI6361008171103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI12-0292OtherMICHIGAN CERTIFICATION BOARD FOR ADDICTION PROFESSIONALS
MI6361008171OtherSTATE OF MICHIGAN