Provider Demographics
NPI:1588253181
Name:BURCHINAL, BOBBI JO (LISW)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:JO
Last Name:BURCHINAL
Suffix:
Gender:
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S MAIN ST # 8
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-3333
Mailing Address - Country:US
Mailing Address - Phone:740-748-0400
Mailing Address - Fax:740-748-0488
Practice Address - Street 1:314 S MAIN ST # 8
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-3333
Practice Address - Country:US
Practice Address - Phone:407-748-0400
Practice Address - Fax:740-748-0488
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI.2405441OtherLISW