Provider Demographics
NPI:1427862374
Name:HICKS, SETH (QMHP-T, MA IN HS)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:HICKS
Suffix:
Gender:M
Credentials:QMHP-T, MA IN HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 IVY KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:GLADYS
Mailing Address - State:VA
Mailing Address - Zip Code:24554-2505
Mailing Address - Country:US
Mailing Address - Phone:661-747-5481
Mailing Address - Fax:
Practice Address - Street 1:66 IVY KNOLL DR
Practice Address - Street 2:
Practice Address - City:GLADYS
Practice Address - State:VA
Practice Address - Zip Code:24554-2505
Practice Address - Country:US
Practice Address - Phone:661-747-5481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0734012182251S00000X
VA171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No251S00000XAgenciesCommunity/Behavioral Health