Individual
DAVID KNICKERBOCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
15898 SAINT CLAIR AVE # 1, EAST LIVERPOOL, OH 43920-9122
(330) 953-0243
Mailing address
204 S CADILLAC DR, BOARDMAN, OH 44512-3324
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
C.1901855-TRNE
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
C.2002851
OH
101YP2500X
Professional Counselor
Primary
E.2203074
OH
Other
Enumeration date
02/07/2020
Last updated
11/27/2023
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