Provider Demographics
NPI:1568295566
Name:HICKS, CAROLINE GRACE (LCMHCA, LCASA)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:GRACE
Last Name:HICKS
Suffix:
Gender:F
Credentials:LCMHCA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 GREENWAY RD STE C
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4991
Mailing Address - Country:US
Mailing Address - Phone:828-820-8066
Mailing Address - Fax:
Practice Address - Street 1:717 GREENWAY RD STE C
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4991
Practice Address - Country:US
Practice Address - Phone:828-820-8066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20118101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health