Provider Demographics
NPI:1508666447
Name:HICKS, IMANI SEMAJ (LCSW)
Entity type:Individual
Prefix:
First Name:IMANI
Middle Name:SEMAJ
Last Name:HICKS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4070 HIGHWAY 81 E
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-6164
Mailing Address - Country:US
Mailing Address - Phone:850-454-8218
Mailing Address - Fax:
Practice Address - Street 1:80 JOSEPH E LOWERY BLVD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-3421
Practice Address - Country:US
Practice Address - Phone:850-454-8218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW230571041C0700X
GACSW0095351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical