Provider Demographics
NPI:1821577545
Name:TICKLE, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:TICKLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 FULTON RD NW STE 103
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3526
Mailing Address - Country:US
Mailing Address - Phone:330-956-5936
Mailing Address - Fax:330-956-5623
Practice Address - Street 1:1930 FULTON RD NW STE 103
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3526
Practice Address - Country:US
Practice Address - Phone:330-956-5936
Practice Address - Fax:330-956-5623
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)