Doctor Name: | MR. RICHARD POLONCHAK |
NPI Number: | 1346458692 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC, CBT |
License Number: | PRC715 |
Business Practice Address: | 234 Deer Mountain Dr Harpers Ferry, WV - 254255490 |
Business Phone Number: | 3048761421 |
Business Fax Number: | 3048761421 |
Mailing Address: | 234 Deer Mountain Dr, HARPERS FERRY |
State: | WV |
Postal Code: | 254255490 |
Phone Number: | 3048761421 |
Fax Number: | 3048761421 |
NPI Enumeration Date: | 05/18/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | PRC715 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | DC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |