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Mr. Dwayne Everett Hicks JR.
Intellectual and/or Developmental Disabilities Residential Treatment Facility in Louisburg, North Carolina
NPI 1821861345

Dwayne Everett Hicks JR. is a Intellectual and/or Developmental Disabilities Residential Treatment Facility based in Louisburg, NC. Dwayne Everett Hicks JR. practices in Louisburg, NC. The NPI Number for Dwayne Everett Hicks JR. is 1821861345 and holds a License No. (North Carolina).

The current practice location address for Dwayne Everett Hicks JR. is 1078 Lake Royale, Louisburg, NC and can be reached out via phone at 252-425-7746.

Location: 1078 Lake Royale, Louisburg, NC, 27549
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1821861345
Provider Name
Dwayne Everett Hicks JR.
Credential
Provider Entity Type
Individual
Gender
Male
Address
1078 Lake Royale, Louisburg, NC, 27549
Phone Number
252-425-7746
Fax Number
Provider Enumeration Date
11/06/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1078 Lake Royale
City
Louisburg
State
North Carolina
Zip
27549
Phone Number
252-425-7746
Fax Number
person
Provider Business Mailing Address Details
Address
1078 Lake Royale
City
Louisburg
State
North Carolina
Zip
27549
Phone Number
252-425-7746
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320600000X
License No.
()
Definition
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.
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