Healthcare Provider Details

I. General information

NPI: 1023882008
Provider Name (Legal Business Name): SHAPUITE COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1113 ROCKWOOD AVE SW
CANTON OH
44710-1421
US

IV. Provider business mailing address

1113 ROCKWOOD AVE SW
CANTON OH
44710-1421
US

V. Phone/Fax

Practice location:
  • Phone: 330-806-0566
  • Fax:
Mailing address:
  • Phone: 330-806-0566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CINDY M SHAPUITE
Title or Position: OWNER
Credential:
Phone: 330-806-0566