Individual
IMANI VICKERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2775 STATE ROUTE 39, SHELBY, OH 44875-9466
(419) 747-3322
Mailing address
405 JENNINGS AVE, MANSFIELD, OH 44907-1400
(567) 307-1145
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.182624
OH
106S00000X
Behavior Technician
—
—
Other
Enumeration date
12/15/2022
Last updated
01/25/2023
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