Healthcare Provider Details

I. General information

NPI: 1508414186
Provider Name (Legal Business Name): CHRISTOPHER LLOYDE MENCKE LICDC, LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N MAIN ST
AKRON OH
44310-1456
US

IV. Provider business mailing address

4600 MONTGOMERY RD
CINCINNATI OH
45212-2697
US

V. Phone/Fax

Practice location:
  • Phone: 833-510-4357
  • Fax: 866-460-2997
Mailing address:
  • Phone: 833-510-4357
  • Fax: 866-460-2997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162140
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1903396
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: