Healthcare Provider Details

I. General information

NPI: 1841925443
Provider Name (Legal Business Name): MEN'S CHALLENGE OF ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 TUSCARAWAS ST E
CANTON OH
44707-3152
US

IV. Provider business mailing address

901 TUSCARAWAS ST E
CANTON OH
44707-3152
US

V. Phone/Fax

Practice location:
  • Phone: 330-205-9515
  • Fax: 330-754-6253
Mailing address:
  • Phone: 330-205-9515
  • Fax: 330-754-6253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KEITH HOCHADEL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 330-205-9515