Individual
KENNETH M. BANCROFT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC-S, LICDC-CS
Contact information
Practice address
150 E MARKET ST, WARREN, OH 44481-1141
(330) 399-6451
(330) 934-6266
Mailing address
150 E MARKET ST, WARREN, OH 44481-1141
(330) 399-6451
(330) 934-6266
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
081074
OH
101YP2500X
Professional Counselor
Primary
E0002540-SUPV
OH
104100000X
Social Worker
S12092
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000125407
ANTHEM
OH
01
—
539304000
MAGELLAN
OH
Enumeration date
01/16/2007
Last updated
12/13/2024
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