Provider Demographics
NPI:1871009308
Name:DOLECKI, MITCHELL JAMES
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:JAMES
Last Name:DOLECKI
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 1:201 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2058
Mailing Address - Country:US
Mailing Address - Phone:330-343-3050
Mailing Address - Fax:330-343-8188
Practice Address - Street 1:567 WABASH AVE NW
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-4143
Practice Address - Country:US
Practice Address - Phone:330-343-3050
Practice Address - Fax:330-343-8188
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000000OtherNONE