Provider Demographics
NPI:1487351615
Name:ROXBY, CELISE'CC' R (BSS, BSP)
Entity type:Individual
Prefix:
First Name:CELISE'CC'
Middle Name:R
Last Name:ROXBY
Suffix:
Gender:F
Credentials:BSS, BSP
Other - Prefix:
Other - First Name:CC
Other - Middle Name:RENEE
Other - Last Name:ROXBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSS, BSP
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:BENWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26031-0007
Mailing Address - Country:US
Mailing Address - Phone:304-559-3199
Mailing Address - Fax:
Practice Address - Street 1:445 MAIN ST
Practice Address - Street 2:
Practice Address - City:BENWOOD
Practice Address - State:WV
Practice Address - Zip Code:26031-1105
Practice Address - Country:US
Practice Address - Phone:304-559-3199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X, 101YA0400X, 103K00000X
WV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV8120209Medicaid