Healthcare Provider Details

I. General information

NPI: 1689340523
Provider Name (Legal Business Name): FAMILY COUNSELING & REHABILITATION CENTER OF OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 LANCASTER ST
MARIETTA OH
45750-2734
US

IV. Provider business mailing address

PO BOX 462
BELPRE OH
45714-0462
US

V. Phone/Fax

Practice location:
  • Phone: 740-249-8061
  • Fax:
Mailing address:
  • Phone: 740-249-8061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ANN SIMMONS
Title or Position: OWNER
Credential: LPCC, LICDC
Phone: 740-249-8061