Healthcare Provider Details

I. General information

NPI: 1538533609
Provider Name (Legal Business Name): NETARSHA FICKLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14733 S TELEGRAPH RD
MONROE MI
48161-9545
US

IV. Provider business mailing address

330 E BEECHER ST
ADRIAN MI
49221-3928
US

V. Phone/Fax

Practice location:
  • Phone: 734-243-8707
  • Fax: 734-243-8710
Mailing address:
  • Phone: 773-968-8389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015272
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: