Provider Demographics
NPI:1861556425
Name:HICKS, RITA VIRGINIA (MFT)
Entity type:Individual
Prefix:MS
First Name:RITA
Middle Name:VIRGINIA
Last Name:HICKS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 PACIFIC BLVD SE STE 101
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-7903
Mailing Address - Country:US
Mailing Address - Phone:541-321-2278
Mailing Address - Fax:541-246-8826
Practice Address - Street 1:2225 PACIFIC BLVD SE STE 101
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-7903
Practice Address - Country:US
Practice Address - Phone:541-321-2278
Practice Address - Fax:541-246-8826
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36108106H00000X
NCLMFT1550106H00000X
WALF60858344106H00000X
ORT1455106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist