Provider Demographics
NPI:1356872733
Name:KONNOFF, JAMES ALEXIS (LCDCII)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALEXIS
Last Name:KONNOFF
Suffix:
Gender:M
Credentials:LCDCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4422
Mailing Address - Country:US
Mailing Address - Phone:435-691-0200
Mailing Address - Fax:
Practice Address - Street 1:209 CENTER ST
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1189
Practice Address - Country:US
Practice Address - Phone:440-205-2670
Practice Address - Fax:440-285-8543
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCII.151078101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)