Individual
JACQUELYN R MCCOMBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHS, LCDC III
Contact information
Practice address
5665 HOOVER RD, GROVE CITY, OH 43123-9280
(614) 875-2371
(614) 875-2116
Mailing address
662 KINGSFORD RD, COLUMBUS, OH 43204-1116
(614) 804-9668
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCDCII.161593
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDCIII.161969
OH
171M00000X
Case Manager/Care Coordinator
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0065539
—
OH
Enumeration date
11/28/2017
Last updated
04/27/2021
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