Healthcare Provider Details

I. General information

NPI: 1518461193
Provider Name (Legal Business Name): STEFANI ANN WHITMIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 10/11/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CROSS STREET
AKRON OH
44311-1026
US

IV. Provider business mailing address

150 CROSS STREET
AKRON OH
44311-1026
US

V. Phone/Fax

Practice location:
  • Phone: 330-996-9141
  • Fax:
Mailing address:
  • Phone: 330-996-9141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDC111.162363
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2207290
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: