Provider Demographics
NPI:1104892942
Name:HICKS, LAUREL (LCSW, LLC)
Entity type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:LCSW, LLC
Other - Prefix:MS
Other - First Name:LAUREL
Other - Middle Name:
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, LCAC
Mailing Address - Street 1:2680 E MAIN ST STE 126
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-2827
Mailing Address - Country:US
Mailing Address - Phone:317-966-8366
Mailing Address - Fax:317-942-0348
Practice Address - Street 1:2680 E MAIN ST
Practice Address - Street 2:SUITE 126
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2825
Practice Address - Country:US
Practice Address - Phone:317-966-8366
Practice Address - Fax:317-837-4901
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004687A1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN39897001Medicaid