Provider Demographics
NPI:1104144286
Name:HICKS, SHANNON ASHLEY (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:ASHLEY
Last Name:HICKS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:ASHLEY
Other - Last Name:HALABOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:45 WILLOW STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103
Mailing Address - Country:US
Mailing Address - Phone:413-781-6556
Mailing Address - Fax:413-781-6523
Practice Address - Street 1:45 WILLOW STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103
Practice Address - Country:US
Practice Address - Phone:413-781-6556
Practice Address - Fax:413-781-6523
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
MA2166851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical