Provider Demographics
NPI:1174330385
Name:HICKS, JENAY (MS, LAPC, NCC)
Entity type:Individual
Prefix:
First Name:JENAY
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:MS, LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3628 PICKERAL ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-3285
Mailing Address - Country:US
Mailing Address - Phone:404-532-8053
Mailing Address - Fax:
Practice Address - Street 1:3628 PICKERAL ST
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-3285
Practice Address - Country:US
Practice Address - Phone:404-532-8053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014640101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor