Provider Demographics
NPI:1578977476
Name:BILLOCK, CHARLES JR (PC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:BILLOCK
Suffix:JR
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 ROBBINS AVE
Mailing Address - Street 2:APT. 302
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-3976
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:552 N PARK AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481-1117
Practice Address - Country:US
Practice Address - Phone:330-392-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1100415101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health