Active NPI
Irene Marie Hicks, CATC
- Addiction (Substance Use Disorder) Counselor
- San Clemente, CA
National Provider Identifier
1649365933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 061337
- Practice address
- 101 Avenida Serra
San Clemente, CA 92672 - Phone
- (949) 366-9210
- Fax
- (949) 498-5706
- NPI assigned
- Oct 4, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 061337 | CA | Primary |
Addresses
Primary practice location
101 Avenida Serra
San Clemente, CA 92672
Mailing address
321 Avenida Cabrillo
#C
San Clemente, CA 92672
Phone (949) 366-9210
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101YA0400X | Other | CA | COUNSELOR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 061337 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Mainstream Group, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Substance Abuse Rehabilitation Facility
- San Clemente, CA
- NPI 1043397466
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1649365933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "321 AVENIDA CABRILLO",
"address_2": "#C",
"city": "SAN CLEMENTE",
"state": "CA",
"postal_code": "92672",
"telephone_number": "949-366-9210",
"fax_number": "949-498-5706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 AVENIDA SERRA",
"city": "SAN CLEMENTE",
"state": "CA",
"postal_code": "92672",
"telephone_number": "949-366-9210",
"fax_number": "949-498-5706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS",
"first_name": "IRENE",
"middle_name": "MARIE",
"credential": "CATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "061337",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COUNSELOR",
"identifier": "101YA0400X",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Clemente, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.