Healthcare Provider Details

I. General information

NPI: 1912443771
Provider Name (Legal Business Name): JENNIFER CULP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N CANFIELD NILES RD STE 110
AUSTINTOWN OH
44515-2332
US

IV. Provider business mailing address

PO BOX 1098
DALLAS NC
28034-1098
US

V. Phone/Fax

Practice location:
  • Phone: 330-798-0491
  • Fax: 330-303-4948
Mailing address:
  • Phone: 330-798-0491
  • Fax: 330-303-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1901030-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: