Provider Demographics
NPI:1245743939
Name:GACNIK, MICHAEL JAMES (LPCC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:GACNIK
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-1420
Mailing Address - Country:US
Mailing Address - Phone:161-491-6700
Mailing Address - Fax:614-916-3055
Practice Address - Street 1:649 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-1420
Practice Address - Country:US
Practice Address - Phone:614-916-7005
Practice Address - Fax:614-916-3055
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1800668101Y00000X
OHC0077084101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor