MEDICARE: DOUGLAS EDWARD HICKEY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	C.2103813	OH

General Provider Information

NPI Number	:	1033845433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS EDWARD HICKEY LPC

Provider Business Mailing Address
First Line	:	761 MIAMISBURG CENTERVILLE RD
Second Line	:
City	:	WASHINGTON TOWNSHIP
State	:	OH
Zip	:	45459-6501
Country	:	US
Telephone Number	:	937-319-4448
Fax Number	:

Provider Business Practice Location Address
First Line	:	761 MIAMISBURG CENTERVILLE RD
Second Line	:
City	:	WASHINGTON TOWNSHIP
State	:	OH
Zip	:	45459-6501
Country	:	US
Telephone Number	:	937-319-4448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2022
Last Update Date	:	07/27/2022

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