Provider Demographics
NPI:1578446027
Name:HICKS, DONTAE (LCSW)
Entity type:Individual
Prefix:
First Name:DONTAE
Middle Name:
Last Name:HICKS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4529 BRECCIA LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-3118
Mailing Address - Country:US
Mailing Address - Phone:863-617-3477
Mailing Address - Fax:
Practice Address - Street 1:4529 BRECCIA LN
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-3118
Practice Address - Country:US
Practice Address - Phone:863-617-3477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW251611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical