Provider Demographics
NPI:1306237193
Name:HUCULAK, REIJA (LISW)
Entity type:Individual
Prefix:
First Name:REIJA
Middle Name:
Last Name:HUCULAK
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6437 MORROW ROSSBURG RD
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:OH
Mailing Address - Zip Code:45152-9544
Mailing Address - Country:US
Mailing Address - Phone:513-221-0057
Mailing Address - Fax:
Practice Address - Street 1:6437 MORROW ROSSBURG RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:OH
Practice Address - Zip Code:45152-9544
Practice Address - Country:US
Practice Address - Phone:513-221-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-15
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.17003411041C0700X
OHLICDC.141221101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)