Provider Demographics
NPI:1881194405
Name:SOPKOVICH, JASON CARL (LPC LICDC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:CARL
Last Name:SOPKOVICH
Suffix:
Gender:M
Credentials:LPC LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 DAY DR UNIT 29054
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5656
Mailing Address - Country:US
Mailing Address - Phone:216-323-9538
Mailing Address - Fax:216-270-7347
Practice Address - Street 1:7801 DAY DR 29054
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5660
Practice Address - Country:US
Practice Address - Phone:216-650-4408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2025-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.162769101YA0400X
OHC.2506972101YM0800X, 101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0154182Medicaid