Provider Demographics
NPI:1902253412
Name:HICKS, KRISTY (LGPC)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 BUSINESS PKWY S
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-3054
Mailing Address - Country:US
Mailing Address - Phone:410-751-7771
Mailing Address - Fax:
Practice Address - Street 1:1106 BUSINESS PKWY S
Practice Address - Street 2:SUITE B
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-3054
Practice Address - Country:US
Practice Address - Phone:410-751-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP6676101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health