Provider Demographics
NPI:1124532635
Name:MACKLIN, RODESCU (LICDC)
Entity type:Individual
Prefix:
First Name:RODESCU
Middle Name:
Last Name:MACKLIN
Suffix:
Gender:M
Credentials:LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5133 KINGSFORD DR
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-1925
Mailing Address - Country:US
Mailing Address - Phone:937-572-5395
Mailing Address - Fax:
Practice Address - Street 1:200 DARUMA PARKWAY
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439
Practice Address - Country:US
Practice Address - Phone:937-267-5098
Practice Address - Fax:937-496-5274
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC-161440101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)