Provider Demographics
NPI:1861068009
Name:NO 1 LADIES ADVOCACY AGENCY
Entity type:Organization
Organization Name:NO 1 LADIES ADVOCACY AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LGSW
Authorized Official - Phone:218-760-7889
Mailing Address - Street 1:516 BELTRAMI AVE NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3010
Mailing Address - Country:US
Mailing Address - Phone:218-760-7889
Mailing Address - Fax:888-375-3627
Practice Address - Street 1:516 BELTRAMI AVE NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3010
Practice Address - Country:US
Practice Address - Phone:218-760-7889
Practice Address - Fax:888-375-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)