Provider Demographics
NPI:1902321060
Name:ROHRBACH, JESSICA (LICDC, LPCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ROHRBACH
Suffix:
Gender:F
Credentials:LICDC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 S MARION ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44818-9201
Mailing Address - Country:US
Mailing Address - Phone:567-207-5377
Mailing Address - Fax:888-518-4977
Practice Address - Street 1:54 S MARION ST
Practice Address - Street 2:
Practice Address - City:BLOOMVILLE
Practice Address - State:OH
Practice Address - Zip Code:44818-9201
Practice Address - Country:US
Practice Address - Phone:567-207-5377
Practice Address - Fax:888-518-4977
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.161682101YA0400X
OHLICDC.162369101YA0400X
OHC.2103377.TRNE101YM0800X
OHE.2404567101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health