Healthcare Provider Details

I. General information

NPI: 1144715574
Provider Name (Legal Business Name): DARLEEN KOTAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5760 PATRIOT BLVD
AUSTINTOWN OH
44515-1170
US

IV. Provider business mailing address

964 N MARKET ST
LISBON OH
44432-9363
US

V. Phone/Fax

Practice location:
  • Phone: 330-953-0243
  • Fax:
Mailing address:
  • Phone: 330-424-1468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC.1901804
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberC.1800952-TRNE
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2404022
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: