Individual
MS. THERESA ISABELLA HICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1665 HERLONG CT STE B, ROCK HILL, SC 29732-1193
(704) 335-9794
Mailing address
9104 BLUE RIDGE DR, FORT MILL, SC 29707-2510
(919) 564-6203
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001011935
NC
Other
Enumeration date
01/25/2021
Last updated
09/16/2024
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