Provider Demographics
NPI:1932166477
Name:HICKEY, KRISTI L (MS LPC NCC)
Entity type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:L
Last Name:HICKEY
Suffix:
Gender:F
Credentials:MS LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22712 CLAIRWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080
Mailing Address - Country:US
Mailing Address - Phone:586-634-7628
Mailing Address - Fax:
Practice Address - Street 1:12434 TWELVE MILE RD
Practice Address - Street 2:STE 201
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093
Practice Address - Country:US
Practice Address - Phone:586-558-7551
Practice Address - Fax:586-573-8016
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008392101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional