Healthcare Provider Details

I. General information

NPI: 1487351615
Provider Name (Legal Business Name): CELISE'CC' R ROXBY BSS, BSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CC RENEE ROXBY BSS, BSP

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 MAIN ST
BENWOOD WV
26031-1105
US

IV. Provider business mailing address

PO BOX 7
BENWOOD WV
26031-0007
US

V. Phone/Fax

Practice location:
  • Phone: 304-559-3199
  • Fax:
Mailing address:
  • Phone: 304-559-3199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: