Healthcare Provider Details

I. General information

NPI: 1427361500
Provider Name (Legal Business Name): DANNA BOZICK LSW, NCC, LICDC, CTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 LOGAN WAY
HUBBARD OH
44425-3311
US

IV. Provider business mailing address

4505 LOGAN WAY
HUBBARD OH
44425-3311
US

V. Phone/Fax

Practice location:
  • Phone: 330-259-3664
  • Fax: 330-259-3665
Mailing address:
  • Phone: 330-259-3664
  • Fax: 330-259-3665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22869
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0910-C02
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number981384
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number601948
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number701089
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number167
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.0016370
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: