Provider Demographics
NPI:1730677386
Name:HICKS, IXCHELLE QUEELEY
Entity type:Individual
Prefix:
First Name:IXCHELLE
Middle Name:QUEELEY
Last Name:HICKS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 COUNTRY TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-5050
Mailing Address - Country:US
Mailing Address - Phone:407-810-4457
Mailing Address - Fax:
Practice Address - Street 1:1700 COUNTRY TERRACE LN
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5050
Practice Address - Country:US
Practice Address - Phone:407-810-4457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH25061101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health