Provider Demographics
NPI:1861260754
Name:HICKS, DARNELL EUGENE
Entity type:Individual
Prefix:
First Name:DARNELL
Middle Name:EUGENE
Last Name:HICKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 E MAPLE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46806-2621
Mailing Address - Country:US
Mailing Address - Phone:260-246-0814
Mailing Address - Fax:
Practice Address - Street 1:3405 E MAPLE GROVE AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46806-2621
Practice Address - Country:US
Practice Address - Phone:260-246-0814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool