Healthcare Provider Details

I. General information

NPI: 1700736733
Provider Name (Legal Business Name): NICHOLAS BLAKE ALLEN-GIBSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7817 HILLS AND DALES RD NW # A
MASSILLON OH
44646-2445
US

IV. Provider business mailing address

7817 HILLS AND DALES RD NW # A
MASSILLON OH
44646-2445
US

V. Phone/Fax

Practice location:
  • Phone: 330-265-6213
  • Fax:
Mailing address:
  • Phone: 330-265-6213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: