Provider Demographics
NPI:1811726391
Name:HICKS, JASMYNE SADE' (LMSW/LGSW)
Entity type:Individual
Prefix:MS
First Name:JASMYNE
Middle Name:SADE'
Last Name:HICKS
Suffix:
Gender:F
Credentials:LMSW/LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10805 OLD FORT RD
Mailing Address - Street 2:
Mailing Address - City:FT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-2636
Mailing Address - Country:US
Mailing Address - Phone:240-877-3215
Mailing Address - Fax:
Practice Address - Street 1:9475 LOTTSFORD RD
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5357
Practice Address - Country:US
Practice Address - Phone:240-326-3027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD31739104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker