Provider Demographics
NPI:1649920497
Name:HICKS, JAMES LEE (AAS CDAC1)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEE
Last Name:HICKS
Suffix:
Gender:M
Credentials:AAS CDAC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:102 OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5931
Mailing Address - Country:US
Mailing Address - Phone:209-735-2633
Mailing Address - Fax:
Practice Address - Street 1:1904 RICHLAND AVE
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-4562
Practice Address - Country:US
Practice Address - Phone:209-525-7411
Practice Address - Fax:209-541-2083
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)