Healthcare Provider Details

I. General information

NPI: 1144537408
Provider Name (Legal Business Name): LAURA KIDD MA ED., LPCC/LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 S MAIN ST
COVENTRY TOWNSHIP OH
44319
US

IV. Provider business mailing address

PO BOX 933132
CLEVELAND OH
44193-0001
US

V. Phone/Fax

Practice location:
  • Phone: 330-644-4095
  • Fax:
Mailing address:
  • Phone: 330-724-5471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number944030
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberE.0002371-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: