Healthcare Provider Details

I. General information

NPI: 1679806681
Provider Name (Legal Business Name): LISA GOJANOVIC PCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 BAKER BLVD
FAIRLAWN OH
44333-3601
US

IV. Provider business mailing address

63 BAKER BLVD
FAIRLAWN OH
44333-3601
US

V. Phone/Fax

Practice location:
  • Phone: 330-572-0641
  • Fax: 330-572-0643
Mailing address:
  • Phone: 330-864-6331
  • Fax: 330-572-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0004081
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: