Healthcare Provider Details

I. General information

NPI: 1760527626
Provider Name (Legal Business Name): JILL R SOKOLNICKI MS, LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL R MARLOW MS, LPCC-S

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3095 KETTERING BLVD
MORAINE OH
45439-1983
US

IV. Provider business mailing address

PO BOX 4503 1111 E. 5TH ST.
DAYTON OH
45401-4503
US

V. Phone/Fax

Practice location:
  • Phone: 937-913-1912
  • Fax: 937-913-1913
Mailing address:
  • Phone: 937-231-6581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE.0008166
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: