Provider Demographics
NPI:1962919373
Name:KOLASINSKI, ROBERT GERARD (CDCA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:GERARD
Last Name:KOLASINSKI
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 JEFFERSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-6956
Mailing Address - Country:US
Mailing Address - Phone:419-242-9955
Mailing Address - Fax:
Practice Address - Street 1:701 JEFFERSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-6956
Practice Address - Country:US
Practice Address - Phone:419-242-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150452101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)