Provider Demographics
NPI:1699904763
Name:HICKS, SHAKOYA (LPC)
Entity type:Individual
Prefix:MRS
First Name:SHAKOYA
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 BOURBON ST STE 119
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7334
Mailing Address - Country:US
Mailing Address - Phone:540-658-2820
Mailing Address - Fax:540-658-2825
Practice Address - Street 1:3330 BOURBON ST STE 119
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7334
Practice Address - Country:US
Practice Address - Phone:540-658-2820
Practice Address - Fax:540-658-2825
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006140101YP2500X
NCS7471101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional