| NPI | 1417295320 |
|---|---|
| Former Name | SHANNON HICKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34006343A) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87001417A) |
| Enumeration Date | 2013-01-28 |
| Last Update Date | 2022-07-27 |