| Licking County Alcoholism Prevention Program | |
|
62 E Stevens St Newark OH 43055-5969 | |
| (740) 366-7303 | |
| (740) 366-7305 |
| Full Name | Licking County Alcoholism Prevention Program |
|---|---|
| Speciality | Counselor |
| Location | 62 E Stevens St, Newark, Ohio |
| Authorized Official Name and Position | John Jordan (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7404039494 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Licking County Alcoholism Prevention Program 62 E Stevens St Newark OH 43055-5969 Ph: (740) 366-7303 | Licking County Alcoholism Prevention Program 62 E Stevens St Newark OH 43055-5969 Ph: (740) 366-7303 |
| NPI Number | 1124089438 |
|---|---|
| Provider Enumeration Date | 03/29/2006 |
| Last Update Date | 02/21/2024 |
| Certification Date | 02/21/2024 |
| Medicare PECOS PAC ID | 9537455266 |
|---|---|
| Medicare Enrollment ID | O20160907001091 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124089438 | NPI | - | NPPES |
| 01322 | Other | OH | ODADAS |
| 45-579-01 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 01322 (Ohio) | Primary |
| Provider Name | Deborah Lynn Esterline |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780038653 PECOS PAC ID: 8123304649 Enrollment ID: I20170418002404 |
| Provider Name | Richard Frederick Sharp |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306927868 PECOS PAC ID: 2163867839 Enrollment ID: I20240304003459 |
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