Provider Demographics
NPI:1205354420
Name:HICKS, DAVID TIMOTHY (MSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:TIMOTHY
Last Name:HICKS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1352
Mailing Address - Country:US
Mailing Address - Phone:270-296-1176
Mailing Address - Fax:
Practice Address - Street 1:105 BANK ST APT 3
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-3533
Practice Address - Country:US
Practice Address - Phone:270-296-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY255686101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor