Healthcare Provider Details

I. General information

NPI: 1154037455
Provider Name (Legal Business Name): JAMES OKOLICA MSW, LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 N MAIN ST STE 5
DAYTON OH
45415-2560
US

IV. Provider business mailing address

439 E RAHN RD
DAYTON OH
45429-5948
US

V. Phone/Fax

Practice location:
  • Phone: 142-793-7791
  • Fax:
Mailing address:
  • Phone: 937-830-2065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2202760-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: