Provider Demographics
NPI:1609577360
Name:IBEBUIKE, JOEL C
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:C
Last Name:IBEBUIKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-2703
Mailing Address - Country:US
Mailing Address - Phone:330-313-9684
Mailing Address - Fax:
Practice Address - Street 1:524 W PARK AVE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-2580
Practice Address - Country:US
Practice Address - Phone:330-753-1096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)