Provider Demographics
NPI:1902975584
Name:BOZZA-HICKS, THERESA LUCILLE (MA, LPC, CMHIMP)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:LUCILLE
Last Name:BOZZA-HICKS
Suffix:
Gender:F
Credentials:MA, LPC, CMHIMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 MARSHWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579
Mailing Address - Country:US
Mailing Address - Phone:843-349-0458
Mailing Address - Fax:
Practice Address - Street 1:4505 MARSHWOOD DR.
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579
Practice Address - Country:US
Practice Address - Phone:843-349-0458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
SC6853101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional