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Individual

BRIAN MICK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
14572 ST RT. 23, WAVERLY, OH 45690
(740) 835-8083
Mailing address
12327 STATE ROUTE 104, WAVERLY, OH 45690-8968

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
101YM0800X
Mental Health Counselor

Other

Enumeration date
02/22/2022
Last updated
02/22/2022
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