Provider Demographics
NPI:1760527626
Name:SOKOLNICKI, JILL R (MS, LPCC-S)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:R
Last Name:SOKOLNICKI
Suffix:
Gender:F
Credentials:MS, LPCC-S
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:R
Other - Last Name:MARLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPCC-S
Mailing Address - Street 1:PO BOX 4503
Mailing Address - Street 2:1111 E. 5TH ST.
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45401-4503
Mailing Address - Country:US
Mailing Address - Phone:937-231-6581
Mailing Address - Fax:
Practice Address - Street 1:3095 KETTERING BLVD
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1983
Practice Address - Country:US
Practice Address - Phone:937-913-1912
Practice Address - Fax:937-913-1913
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0008166101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE.0008166OtherSTATE OF OHIO SUPERVISING PROFESSIONAL CLINICAL COUNSELOR LICENSE