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1790226264
ALEX MICHAEL HICKINBOTHAM
MANSFIELD, OH
NPI
1790226264
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: OH 141590)
Enumeration Date
2017-03-16
Last Update Date
2017-03-16
Business Address
Mr. ALEX MICHAEL HICKINBOTHAM CDCA
680 PARK AVE W
MANSFIELD, OH 44906-3706
Phone number: 419-528-5993
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Mailing Address
Mr. ALEX MICHAEL HICKINBOTHAM CDCA
876 ARLINGTON AVE
MANSFIELD, OH 44903-7020
Phone number: 419-632-0127
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