MEDICARE: MRS. LANELLE R DARDIE LPC

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	101YP2500X	Professional Counselor	C.0800495	OH

General Provider Information

NPI Number	:	1619276581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LANELLE R DARDIE LPC

Provider Business Mailing Address
First Line	:	339 FALLS AVE
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-3909
Country	:	US
Telephone Number	:	330-261-3393
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 SCHNEIDER ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44721-3349
Country	:	US
Telephone Number	:	330-470-4061
Fax Number	:

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

Provider Enumeration Date	:	03/17/2011
Last Update Date	:	02/11/2020

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