Provider Demographics
NPI:1811078769
Name:HICKS, ROMONA JOY (LCSW)
Entity type:Individual
Prefix:
First Name:ROMONA
Middle Name:JOY
Last Name:HICKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:118 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3636
Mailing Address - Country:US
Mailing Address - Phone:615-278-2241
Mailing Address - Fax:615-904-9182
Practice Address - Street 1:1805 INGLESIDE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-2105
Practice Address - Country:US
Practice Address - Phone:423-745-8802
Practice Address - Fax:423-744-7064
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN8311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3692179Medicare ID - Type Unspecified