Provider Demographics
NPI:1619152907
Name:JANCHAR, MARY JO (LISW, LICDC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JO
Last Name:JANCHAR
Suffix:
Gender:F
Credentials:LISW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-3803
Mailing Address - Country:US
Mailing Address - Phone:419-289-7675
Mailing Address - Fax:419-289-2349
Practice Address - Street 1:310 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3803
Practice Address - Country:US
Practice Address - Phone:419-289-7675
Practice Address - Fax:419-289-2349
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH902799101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)