Healthcare Provider Details

I. General information

NPI: 1235582347
Provider Name (Legal Business Name): NEWPORT COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 S BROAD ST SUITE 401B
CANFIELD OH
44406-1442
US

IV. Provider business mailing address

132 S BROAD ST SUITE 401B
CANFIELD OH
44406-1442
US

V. Phone/Fax

Practice location:
  • Phone: 330-286-4008
  • Fax: 330-286-4008
Mailing address:
  • Phone: 330-286-4008
  • Fax: 330-286-4008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE.0800048
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberE.0800048
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberICDC.161123-CS
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0800048
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0800048
License Number StateOH

VIII. Authorized Official

Name: MRS. KRISTA J. WASSER
Title or Position: OWNER
Credential: MA.ED.,LPCC;LICDC-CS
Phone: 330-286-4008