Healthcare Provider Details

I. General information

NPI: 1700994050
Provider Name (Legal Business Name): ANTHONY JOSEPH CICCONE LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2432 SOUTH RACCOON
AUSTINTOWN OH
44515
US

IV. Provider business mailing address

5208 WEST VIOLA
AUSTINTOWN OH
44515-1836
US

V. Phone/Fax

Practice location:
  • Phone: 330-799-9851
  • Fax: 330-792-2347
Mailing address:
  • Phone: 330-799-9851
  • Fax: 330-792-2347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0002810
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: