Provider Demographics
NPI:1043674070
Name:TAKACS, JAMES (LICDC-CS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:TAKACS
Suffix:
Gender:M
Credentials:LICDC-CS
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:TAKACS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICDC-CS
Mailing Address - Street 1:35 JONQUIL DR SW
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:OH
Mailing Address - Zip Code:43062
Mailing Address - Country:US
Mailing Address - Phone:740-927-5507
Mailing Address - Fax:
Practice Address - Street 1:62 E STEVENS ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5969
Practice Address - Country:US
Practice Address - Phone:740-366-7303
Practice Address - Fax:740-366-7305
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH88436101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)