Provider Demographics
NPI:1306482096
Name:HICKS, DONNA A (MA LPC, LCDC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:A
Last Name:HICKS
Suffix:
Gender:F
Credentials:MA LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5462 DIAMONDBACK TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-4025
Mailing Address - Country:US
Mailing Address - Phone:210-426-9500
Mailing Address - Fax:
Practice Address - Street 1:601 N FRIO ST BLDG 2
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3011
Practice Address - Country:US
Practice Address - Phone:210-261-3001
Practice Address - Fax:210-731-9661
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15112101YA0400X
TX83038101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)