Provider Demographics
NPI:1699761809
Name:DRUE, ROEHNELL J (PCC, LICDC)
Entity type:Individual
Prefix:
First Name:ROEHNELL
Middle Name:J
Last Name:DRUE
Suffix:
Gender:F
Credentials:PCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 GEORGIAN WAY
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1502
Mailing Address - Country:US
Mailing Address - Phone:740-454-4456
Mailing Address - Fax:740-454-8183
Practice Address - Street 1:3620 COURT DR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-6456
Practice Address - Country:US
Practice Address - Phone:740-454-4456
Practice Address - Fax:740-454-8183
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001392101YA0400X
OHE-0003726101YM0800X
N/A101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH472735000OtherMAGELLAN BEH. HEALTH PIN
OH000000300433OtherANTHEM BS/BS PIN