Individual
DANTAVIOUS HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LGPC
Contact information
Practice address
6802 MCCLEAN BLVD, BALTIMORE, MD 21234-7200
(410) 444-3800
Mailing address
6802 MCCLEAN BLVD, BALTIMORE, MD 21234-7200
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LGP11368
MD
Other
Enumeration date
04/30/2021
Last updated
04/30/2021
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