Healthcare Provider Details

I. General information

NPI: 1831541481
Provider Name (Legal Business Name): JACQUELINE POLLOK, LPCC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 OLD HENDERSON RD SUITE 216
COLUMBUS OH
43220-3623
US

IV. Provider business mailing address

1170 OLD HENDERSON RD SUITE 216
COLUMBUS OH
43220-3623
US

V. Phone/Fax

Practice location:
  • Phone: 614-842-7999
  • Fax:
Mailing address:
  • Phone: 614-842-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE POLLOK
Title or Position: SOLE PROPRIETOR
Credential: LPCC, LICDC
Phone: 614-842-7999