Provider Demographics
NPI:1154037455
Name:OKOLICA, JAMES (MSW, LSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:OKOLICA
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 E RAHN RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5948
Mailing Address - Country:US
Mailing Address - Phone:937-830-2065
Mailing Address - Fax:
Practice Address - Street 1:7211 N MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2560
Practice Address - Country:US
Practice Address - Phone:142-793-7791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2202760-TRNE104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker