MEDICARE: FAITH MARIE PALMER C.D.C.A.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1538771282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAITH MARIE PALMER C.D.C.A.

Provider Business Mailing Address
First Line	:	2861 E MARKET ST
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-6263
Country	:	US
Telephone Number	:	330-980-2353
Fax Number	:	234-312-9579

Provider Business Practice Location Address
First Line	:	2703 MAHONING AVE STE 105
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44509-2337
Country	:	US
Telephone Number	:	330-781-5107
Fax Number	:	234-312-9579

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

Provider Enumeration Date	:	08/22/2020
Last Update Date	:	08/22/2020

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