Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 14913 | FL |
NPI | 1275915548 |
---|---|
Provider Name | Dr. Jamie K Hicks |
First Address | Kingman, AZ 86409-1779 |
Second Address | Kingman, AZ 86401-8003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2015 |
Last Update Date | 23/06/2015 |