Healthcare Provider Details

I. General information

NPI: 1104741347
Provider Name (Legal Business Name): AALEYAH LYNETTE HARGRAVE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MEDICAL PARK DR
DOVER OH
44622
US

IV. Provider business mailing address

7455 QUAIL HOLLOW ST NW APT C37
MASSILLON OH
44646-2492
US

V. Phone/Fax

Practice location:
  • Phone: 330-343-6621
  • Fax:
Mailing address:
  • Phone: 330-343-6631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberS.2614136
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: