Healthcare Provider Details

I. General information

NPI: 1215339916
Provider Name (Legal Business Name): GREGORY JURICA LICDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W MARKET ST
AKRON OH
44313-6927
US

IV. Provider business mailing address

1900 W MARKET ST
AKRON OH
44313-6927
US

V. Phone/Fax

Practice location:
  • Phone: 234-901-2590
  • Fax: 330-869-0543
Mailing address:
  • Phone: 234-901-2590
  • Fax: 330-869-0543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.161520
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: