Individual
JAHNAE ALEXIS MATLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICDC
Contact information
Practice address
9083 MENTOR AVE, MENTOR, OH 44060-6462
(440) 255-0678
Mailing address
9083 MENTOR AVE, MENTOR, OH 44060-6462
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
161066
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LICDC.161066
OH
Other
Enumeration date
11/28/2016
Last updated
11/05/2024
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