Provider Demographics
NPI:1386069490
Name:HICKS, CATRESA MONIQUE (LPC)
Entity type:Individual
Prefix:MRS
First Name:CATRESA
Middle Name:MONIQUE
Last Name:HICKS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CATRESA
Other - Middle Name:MONIQUE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:57 WHITE OAKS RD
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-1086
Mailing Address - Country:US
Mailing Address - Phone:708-679-9137
Mailing Address - Fax:708-503-6267
Practice Address - Street 1:57 WHITE OAKS RD
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-1086
Practice Address - Country:US
Practice Address - Phone:708-679-9137
Practice Address - Fax:708-503-6267
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.006409101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor