Individual
MR. ALEX MICHAEL HICKINBOTHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
680 PARK AVE W, MANSFIELD, OH 44906-3706
(419) 528-5993
Mailing address
876 ARLINGTON AVE, MANSFIELD, OH 44903-7020
(419) 632-0127
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
141590
OH
Other
Enumeration date
03/16/2017
Last updated
03/16/2017
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