Basic Information
| Provider Information | |||||||||
| NPI: | 1740789007 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HICKS | ||||||||
| FirstName: | MARSHA | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 58 JOHN DYER WAY | ||||||||
| Address2: | |||||||||
| City: | DOYLESTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189029607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158968191 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22 S STATE ST | ||||||||
| Address2: | |||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189403507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155794116 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2018 | ||||||||
| LastUpdateDate: | 02/01/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | PC010194 | PA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.