Provider Demographics
NPI:1629402292
Name:SAVAGE, JENICA M (LPCC)
Entity Type:Individual
Prefix:
First Name:JENICA
Middle Name:M
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 STATE ROUTE 664 N STE C
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-8541
Mailing Address - Country:US
Mailing Address - Phone:740-385-6594
Mailing Address - Fax:740-385-0852
Practice Address - Street 1:541 STATE ROUTE 664 N STE C
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-8541
Practice Address - Country:US
Practice Address - Phone:740-385-6594
Practice Address - Fax:740-385-0852
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1300465101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional