Provider Demographics
NPI:1346458692
Name:POLONCHAK, RICHARD (LPC, CBT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:POLONCHAK
Suffix:
Gender:M
Credentials:LPC, CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 DEER MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425-5490
Mailing Address - Country:US
Mailing Address - Phone:304-876-1421
Mailing Address - Fax:304-876-1421
Practice Address - Street 1:234 DEER MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:HARPERS FERRY
Practice Address - State:WV
Practice Address - Zip Code:25425-5490
Practice Address - Country:US
Practice Address - Phone:304-876-1421
Practice Address - Fax:304-876-1421
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC715101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional