Healthcare Provider Details

I. General information

NPI: 1043258767
Provider Name (Legal Business Name): CONCORD COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BROOKSEDGE BLVD
WESTERVILLE OH
43081-2820
US

IV. Provider business mailing address

700 BROOKSEDGE BLVD
WESTERVILLE OH
43081-2820
US

V. Phone/Fax

Practice location:
  • Phone: 614-882-9338
  • Fax: 614-882-3401
Mailing address:
  • Phone: 614-882-9338
  • Fax: 614-882-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0213
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0213
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0213
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA JAKES
Title or Position: EXECUTIVE DIRECTOR
Credential: LISW
Phone: 614-882-9338