Healthcare Provider Details

I. General information

NPI: 1477302545
Provider Name (Legal Business Name): ADRIAN WALDRON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 BOARDMAN CANFIELD RD
BOARDMAN OH
44512-4223
US

IV. Provider business mailing address

2980 BELMONT AVE
YOUNGSTOWN OH
44505-1834
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-0101
  • Fax: 330-758-0128
Mailing address:
  • Phone: 234-228-8315
  • Fax: 330-759-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2506992
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: