Provider Demographics
NPI:1851996433
Name:TUCHOLSKI, BECKY (PEER RECOVERY)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:TUCHOLSKI
Suffix:
Gender:F
Credentials:PEER RECOVERY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 ENTERPRISE DR NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-8706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4930 ENTERPRISE DR NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481-8706
Practice Address - Country:US
Practice Address - Phone:330-787-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH170818324500000X
OH004365175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility