Provider Demographics
NPI:1962169318
Name:HICKS MARSHALL, DAMMEON BERNARD (LMSW)
Entity type:Individual
Prefix:
First Name:DAMMEON
Middle Name:BERNARD
Last Name:HICKS MARSHALL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 CHAMBLEE TUCKER RD
Mailing Address - Street 2:STE A #288
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3631 CHAMBLEE TUCKER RD
Practice Address - Street 2:STE A #288
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-3034
Practice Address - Country:US
Practice Address - Phone:404-491-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW010363104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker