Provider Demographics
NPI:1366178824
Name:HICKEY, MICHELE (LPC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:HICKEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7652 KATY DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3619
Mailing Address - Country:US
Mailing Address - Phone:937-371-1381
Mailing Address - Fax:
Practice Address - Street 1:761 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45459-6501
Practice Address - Country:US
Practice Address - Phone:937-319-4448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103838101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional