Individual
CHANEL HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1601 GAYLE TER, FREDERICKSBURG, VA 22401-2639
(248) 761-4416
Mailing address
1601 GAYLE TER, FREDERICKSBURG, VA 22401-2639
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0704007477
VA
Other
Enumeration date
03/13/2024
Last updated
03/13/2024
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