Healthcare Provider Details

I. General information

NPI: 1518996362
Provider Name (Legal Business Name): MARY ANN FLICKINGER MA MED LPCC LSW NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 STATE ROUTE 125 SUITE 202
AMELIA OH
45102-1360
US

IV. Provider business mailing address

2504 MONTANA AVENUE
CINCINNATI OH
45211-3766
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-5103
  • Fax: 513-947-9103
Mailing address:
  • Phone: 513-662-1306
  • Fax: 513-947-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE2816
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: