Provider Demographics
NPI:1538533609
Name:FICKLEN, NETARSHA
Entity type:Individual
Prefix:
First Name:NETARSHA
Middle Name:
Last Name:FICKLEN
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 1:330 E BEECHER ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-3928
Mailing Address - Country:US
Mailing Address - Phone:773-968-8389
Mailing Address - Fax:
Practice Address - Street 1:14733 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-9545
Practice Address - Country:US
Practice Address - Phone:734-243-8707
Practice Address - Fax:734-243-8710
Is Sole Proprietor?:No
Enumeration Date:2015-11-30
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015272101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional