Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 9941 | NC |
NPI | 1295025419 |
---|---|
Provider Name | John B Hicks |
First Address | Davidson, NC 28036-8816 |
Second Address | Davidson, NC 28036-8816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2011 |
Last Update Date | 08/04/2011 |