Healthcare Provider Details

I. General information

NPI: 1144463126
Provider Name (Legal Business Name): MICHELE ROOKER MA, LPCC-S, LLCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E MOUND ST
COLUMBUS OH
43215-5595
US

IV. Provider business mailing address

455 E MOUND ST
COLUMBUS OH
43215-5595
US

V. Phone/Fax

Practice location:
  • Phone: 614-242-1284
  • Fax:
Mailing address:
  • Phone: 614-242-1284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number976096
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberE.0004022-SUPV
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number976096
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0004022-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: