Provider Demographics
NPI:1427240068
Name:HICKS, ANNA AMBERG
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:AMBERG
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:CAROLINE
Other - Last Name:AMBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1848 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-5085
Mailing Address - Country:US
Mailing Address - Phone:803-737-8835
Mailing Address - Fax:803-776-6998
Practice Address - Street 1:1848 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-5085
Practice Address - Country:US
Practice Address - Phone:803-737-8835
Practice Address - Fax:803-776-6998
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6300101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health