Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003151275 |
---|---|
Provider Name | Carolyn L Hicks |
First Address | Concord, NC 28025-1894 |
Second Address | Monroe, NC 28110-2818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2012 |
Last Update Date | 29/11/2012 |