Individual
SHANNON HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1673 MASON AVE STE 100, DAYTONA BEACH, FL 32117-5516
(386) 846-3955
(386) 873-0366
Mailing address
1673 MASON AVE STE 100, DAYTONA BEACH, FL 32117-5516
(386) 846-3955
(386) 873-0366
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112144800
—
FL
Enumeration date
06/09/2012
Last updated
05/05/2022
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