Individual
CARRON ICKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW, CDCA
Contact information
Practice address
897 E IRON AVE, DOVER, OH 44622-2030
(330) 343-5555
Mailing address
897 E IRON AVE, DOVER, OH 44622-2030
(330) 343-5555
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
060327
OH
104100000X
Social Worker
Primary
1440286
OH
Other
Enumeration date
11/26/2014
Last updated
11/26/2014
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