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General NPI Number Information
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NPI Number | 1346061538
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Entity Type | Individual
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Provider Name | JAMES MARTIN ROMANCHIK JR. CDCA-PRE
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Gender | Male
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 127 E LIBERTY ST
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City | WOOSTER
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State | OH
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Zip | 44691-4395
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Country | US
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Telephone | 330-636-1741
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Fax |
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Provider Business Mailing Address
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Address Line | 5965 BONETA RD
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City | MEDINA
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State | OH
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Zip | 44256-8760
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Country | US
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Telephone | 440-465-7043
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.190333
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License Number State | OH
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