Healthcare Provider Details

I. General information

NPI: 1538431044
Provider Name (Legal Business Name): VULKASINOVICH & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4134 LINDEN AVENUE SUITE 200
DAYTON OH
45432-3035
US

IV. Provider business mailing address

4134 LINDEN AVENUE SUITE 200
DAYTON OH
45432-3035
US

V. Phone/Fax

Practice location:
  • Phone: 937-369-3020
  • Fax: 937-254-2117
Mailing address:
  • Phone: 937-369-3020
  • Fax: 937-254-2117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE3246
License Number StateOH

VIII. Authorized Official

Name: KEITH ANTHONY VULKASINOVICH
Title or Position: OWNER/CEO
Credential: MSED
Phone: 937-369-3020