Provider Demographics
NPI:1144367558
Name:LAMB, MICKI S (LPCC, CCDC I)
Entity type:Individual
Prefix:
First Name:MICKI
Middle Name:S
Last Name:LAMB
Suffix:
Gender:F
Credentials:LPCC, CCDC I
Other - Prefix:
Other - First Name:MICKI
Other - Middle Name:S
Other - Last Name:GLASSBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC, CCDC I
Mailing Address - Street 1:90 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2301
Mailing Address - Country:US
Mailing Address - Phone:740-593-3682
Mailing Address - Fax:740-594-5642
Practice Address - Street 1:90 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2301
Practice Address - Country:US
Practice Address - Phone:740-593-3682
Practice Address - Fax:740-594-5642
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH991766101YA0400X
OHE.0003727-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)