Individual
JEFFREY J KOSIBA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
2115 WESTPARK DRIVE, LORAIN, OH 44053
(440) 989-4987
Mailing address
2115 W PARK DR, LORAIN, OH 44053-1138
(440) 989-4987
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.161599
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CDCA.161599
LICENSE
OH
Enumeration date
08/30/2017
Last updated
08/30/2017
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