Provider Demographics
NPI:1043695075
Name:HICKS, EBONY A (MSW,CAP)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:A
Last Name:HICKS
Suffix:
Gender:F
Credentials:MSW,CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 W 49TH ST # 147
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2924
Mailing Address - Country:US
Mailing Address - Phone:786-475-1199
Mailing Address - Fax:
Practice Address - Street 1:1581 W 49TH ST # 147
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2924
Practice Address - Country:US
Practice Address - Phone:786-475-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No174H00000XOther Service ProvidersHealth Educator