Christine McCollum, LICDC, OCPSII, MACM

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LICDC.111100 Issued in OH

Practice address

930 Trailwood Dr
Boardman, OH 44512-5007

Phone

(513) 834-7063

NPI assigned

Apr 7, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Christine Kraemer Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Commquest Services, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Canton, OH
  • NPI 1841550696

  Addiction (Substance Use Disorder)

  NPD (past)
• Quest Recovery and Prevention Services, Inc.

  • Community/Behavioral Health Agency
  • Canton, OH
  • NPI 1962831685
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1770902702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 ELSINORE PL STE 200",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452021459",
            "telephone_number": "513-834-7063",
            "fax_number": "513-873-1567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 TRAILWOOD DR",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445125007",
            "telephone_number": "513-834-7063"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "811 Faircrest St SW",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "OH",
            "postal_code": "447064844",
            "country_code": "US",
            "telephone_number": "330-639-4408",
            "fax_number": "330-639-4436",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCOLLUM",
        "first_name": "CHRISTINE",
        "credential": "LICDC, OCPSII, MACM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-07",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LICDC111100",
            "primary": false
        },
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "OH",
            "license": "OCPC1061",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LICDC.111100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0199144",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTINE",
            "last_name": "KRAEMER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kimberly McCann
• Tara McCarrel, LSW
• Patrick Lee McCarthy, PT, DPT, CSCS
• Matthew Albert McClelland, LISW
• McClurg Senior Care LLC
• Jean A McConnell-Copploe, P.T.
• Megan Elizabeth McConnell, LPCC
• Rhonna Lee McConnell
• Amanda Sue McCormick, CNP
• Amanda McCullough

• Addiction (Substance Use Disorder) Counselor in Boardman, OH
• Providers in Boardman, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.