Healthcare Provider Details

I. General information

NPI: 1902321060
Provider Name (Legal Business Name): JESSICA ROHRBACH LICDC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 S MARION ST
BLOOMVILLE OH
44818-9201
US

IV. Provider business mailing address

54 S MARION ST
BLOOMVILLE OH
44818-9201
US

V. Phone/Fax

Practice location:
  • Phone: 567-207-5377
  • Fax: 888-518-4977
Mailing address:
  • Phone: 567-207-5377
  • Fax: 888-518-4977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.161682
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162369
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2103377.TRNE
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2404567
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: