Provider Demographics
NPI:1396077889
Name:HICKS, BETTY ANNE (MS DEGREE)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:ANNE
Last Name:HICKS
Suffix:
Gender:F
Credentials:MS DEGREE
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1100 CESERY BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-5612
Mailing Address - Country:US
Mailing Address - Phone:904-745-3070
Mailing Address - Fax:904-745-3086
Practice Address - Street 1:1100 CESERY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5612
Practice Address - Country:US
Practice Address - Phone:904-745-3070
Practice Address - Fax:904-745-3086
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health