Provider Demographics
NPI:1801333687
Name:HICKS, SHERRI (LCSW)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2152 S VINEYARD STE 110
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6881
Mailing Address - Country:US
Mailing Address - Phone:480-241-9824
Mailing Address - Fax:
Practice Address - Street 1:2152 S VINEYARD
Practice Address - Street 2:STE. 110
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6881
Practice Address - Country:US
Practice Address - Phone:480-241-9824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2019-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15469104100000X
AZ181471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ843407923OtherIRS