MEDICARE: LIA VANADIA CT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	C.2002839-TRNE	OH

General Provider Information

NPI Number	:	1255005096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIA VANADIA CT

Provider Business Mailing Address
First Line	:	6753 STATE RD
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44134-4517
Country	:	US
Telephone Number	:	440-843-5544
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E TALLMADGE AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44310-2373
Country	:	US
Telephone Number	:	330-724-9059
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2021
Last Update Date	:	08/05/2021

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Directions to “ LIA VANADIA CT” Practice Location

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