Healthcare Provider Details

I. General information

NPI: 1053995654
Provider Name (Legal Business Name): ASHLEY SYROID LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3757 CLEVELAND AVE NW
CANTON OH
44709-2374
US

IV. Provider business mailing address

3939 MASSILLON RD STE 801
GREEN OH
44685-6710
US

V. Phone/Fax

Practice location:
  • Phone: 330-415-9559
  • Fax:
Mailing address:
  • Phone: 330-415-9559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: