Individual
MR. EMIL JAY KOLICK VIII
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.
Contact information
Practice address
536 ONWARD AVE, PHOENIXVILLE, PA 19460-5928
(484) 302-4425
Mailing address
536 ONWARD AVE, PHOENIXVILLE, PA 19460-5928
(484) 302-4425
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
I0147
PA
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
4498
PA
101YA0400X
Addiction (Substance Use Disorder) Counselor
4759
PA
101YA0400X
Addiction (Substance Use Disorder) Counselor
FAC-K1308300929
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4498
PCB CERTIFIED ALCOHOL AND DRUG COUNSELOR
PA
01
—
4759
PCB ASSOCIATE PREVENTION SPECIALIST II
PA
01
—
502300
IC&RC CERTIFIED CRIMINAL JUSTICE ADDICTIONS PROFESSIONAL
—
01
—
802836
IC&RC CERTIFIED ALCOHOL AND DRUG COUNSELOR
—
01
—
FAC-K1308300929
FORENSIC ADDICTIONS COUNSELOR: BREINING INSTITUTE
—
01
—
I0147
PCB CERTIFIED INTERVENTION PROFESSIONAL
PA
Enumeration date
01/16/2015
Last updated
01/16/2015
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