Healthcare Provider Details

I. General information

NPI: 1942650965
Provider Name (Legal Business Name): MARRIAGE & FAM MATTERS COUNSELING AND EDUCATION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 PRINCETON GLENDALE RD STE 105
WEST CHESTER OH
45069-1677
US

IV. Provider business mailing address

8300 PRINCETON GLENDALE RD STE 105
WEST CHESTER OH
45069-1677
US

V. Phone/Fax

Practice location:
  • Phone: 513-714-4430
  • Fax:
Mailing address:
  • Phone: 513-714-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NICHOLE S HICKMAN
Title or Position: OWNER
Credential: LPCC
Phone: 513-420-4522