Provider Demographics
NPI:1134949449
Name:GULLICK, MARIAH KIERA (ASSIOCIATES)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:KIERA
Last Name:GULLICK
Suffix:
Gender:F
Credentials:ASSIOCIATES
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:KIERA
Other - Last Name:GULLICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:628 N HAZELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-1706
Mailing Address - Country:US
Mailing Address - Phone:330-519-2936
Mailing Address - Fax:
Practice Address - Street 1:1051 TIFFANY S
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-1977
Practice Address - Country:US
Practice Address - Phone:855-629-6277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst