Provider Demographics
NPI:1386811917
Name:AXE, JODI LYNN (CAC, CCJS, MFT, SAP)
Entity type:Individual
Prefix:MISS
First Name:JODI
Middle Name:LYNN
Last Name:AXE
Suffix:
Gender:F
Credentials:CAC, CCJS, MFT, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NEW SALEM RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:281 WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:OLIVER
Practice Address - State:PA
Practice Address - Zip Code:15472
Practice Address - Country:US
Practice Address - Phone:724-438-3576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)