Hicks, Shannon

Hicks, Shannon is an individual health care provider with primary practice located at 1673 Mason Ave Ste 100 , Daytona Beach FL 32117-5516. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Case Manager/Care Coordinator, Behavioral Health & Social Service Providers / Social Worker. Behavioral Health & Social Service Providers / Social Worker is her primary health care specialty. Hicks, Shannon can be contacted via phone (386) 846-3955.

Contact Information

Primary practice address
1673 Mason Ave Ste 100 Daytona Beach FL 32117-5516
Phone: (386) 846-3955
Fax: (386) 873-0366
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Case Manager/Care Coordinator 171M00000X
Behavioral Health & Social Service Providers / Social Worker 104100000X

Profile Details

NPI number 1679835375
LBN Legal business name Hicks, Shannon
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 9th, 2012
Last updated May 5th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679835375 NPPES
Florida MEDICAID 112144800

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