Individual
VIVIAN HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
79 LILLY CREEK LN, JAMESTOWN, KY 42629-7924
(253) 625-0141
(253) 302-5406
Mailing address
79 LILLY CREEK LN, JAMESTOWN, KY 42629-7924
(253) 625-0141
(253) 302-5406
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CO 60457984
WA
101YM0800X
Mental Health Counselor
275012
KY
101YM0800X
Mental Health Counselor
Primary
MC60587450
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
275012
KENTUCKY LPCC LICENSE
KY
01
—
4397
ALABAMA STATE LICENSE
AL
01
—
CO 60457984
WASHINGTON STATE CDPT
WA
01
—
LH60776174
MENTAL HEALTH COUNSELOR LICENSE
WA
01
—
MC60587450
WASHINGTON STATE LMHCA
WA
Enumeration date
09/11/2014
Last updated
06/12/2023
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