Provider Demographics
NPI:1750615969
Name:FRICKS, JAMES KEITH (LAPC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:KEITH
Last Name:FRICKS
Suffix:
Gender:M
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BROOK VALLEY CT SW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-3844
Mailing Address - Country:US
Mailing Address - Phone:706-252-1223
Mailing Address - Fax:
Practice Address - Street 1:16 BROOK VALLEY CT SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-3844
Practice Address - Country:US
Practice Address - Phone:706-252-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006020101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional