Provider Demographics
NPI:1285422832
Name:HICKS, SHA'KIRA S
Entity type:Individual
Prefix:
First Name:SHA'KIRA
Middle Name:S
Last Name:HICKS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 ARROW HEAD DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL
Mailing Address - State:SC
Mailing Address - Zip Code:29630-8505
Mailing Address - Country:US
Mailing Address - Phone:864-635-5476
Mailing Address - Fax:
Practice Address - Street 1:364 ARROW HEAD DR
Practice Address - Street 2:
Practice Address - City:CENTRAL
Practice Address - State:SC
Practice Address - Zip Code:29630-8505
Practice Address - Country:US
Practice Address - Phone:864-635-5476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRBT-24-385950106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician