Provider Demographics
NPI:1437512548
Name:SNOKE, LORETTA KAYE (LICDC)
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:KAYE
Last Name:SNOKE
Suffix:
Gender:F
Credentials:LICDC
Other - Prefix:MS
Other - First Name:LORETTA
Other - Middle Name:KAYE
Other - Last Name:SNOKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICDC
Mailing Address - Street 1:271 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5725
Mailing Address - Country:US
Mailing Address - Phone:740-364-7248
Mailing Address - Fax:740-366-7305
Practice Address - Street 1:62 E STEVENS ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5969
Practice Address - Country:US
Practice Address - Phone:740-364-7248
Practice Address - Fax:740-366-7305
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011120101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)