Individual
MIKAL ASHLEY HICKS-BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4200 MONUMENT RD, PHILADELPHIA, PA 19131-1625
(215) 581-3701
(215) 581-3993
Mailing address
4200 MONUMENT RD, PHILADELPHIA, PA 19131-1625
(215) 977-2000
(215) 581-3993
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
OT015506
PA
Other
Enumeration date
02/13/2014
Last updated
02/11/2020
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