Healthcare Provider Details

I. General information

NPI: 1598910739
Provider Name (Legal Business Name): PAUL G CZERNIK LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E MAIN ST
GREENVILLE OH
45331-1913
US

IV. Provider business mailing address

212 E MAIN ST
GREENVILLE OH
45331-1913
US

V. Phone/Fax

Practice location:
  • Phone: 937-548-1635
  • Fax:
Mailing address:
  • Phone: 937-548-1635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberS.0027564
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number970016
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberS0027564
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: