Provider Demographics
NPI:1679125314
Name:HICKS, DORA (LPC, M ED)
Entity type:Individual
Prefix:MS
First Name:DORA
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:LPC, M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 SCOUTING CIR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-2540
Mailing Address - Country:US
Mailing Address - Phone:956-494-3123
Mailing Address - Fax:
Practice Address - Street 1:153 SCOUTING CIR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-2540
Practice Address - Country:US
Practice Address - Phone:956-494-3123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75894101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75894OtherLICENSED PROFESSIONAL COUNSELING