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Individual

BRENETTA HICKS-JONES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1318 S COATI DR, TUCSON, AZ 85713-1218
(520) 623-1022
Mailing address
1318 S COATI DR, TUCSON, AZ 85713-1218
(520) 623-1022

Taxonomy

Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH-3839
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
BH-3938
AZ DEPT OF HEALTH SERVICES
AZ
Enumeration date
11/17/2011
Last updated
11/17/2011
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