Provider Demographics
NPI:1265918254
Name:HICKS, DOMONIKE A
Entity type:Individual
Prefix:
First Name:DOMONIKE
Middle Name:A
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SALISBURY ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2221
Mailing Address - Country:US
Mailing Address - Phone:401-470-3045
Mailing Address - Fax:
Practice Address - Street 1:5 SALISBURY ST APT 2
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2221
Practice Address - Country:US
Practice Address - Phone:401-470-3045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker