Provider Demographics
NPI:1053753897
Name:HICKS, ASHLEY A (LMFT)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:A
Last Name:HICKS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 CARMACK RD STE 110L
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1002
Mailing Address - Country:US
Mailing Address - Phone:614-688-0763
Mailing Address - Fax:
Practice Address - Street 1:1080 CARMACK RD STE 110L
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1002
Practice Address - Country:US
Practice Address - Phone:614-688-0763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY170725106H00000X
OHF.2100189106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846675Medicaid