Healthcare Provider Details

I. General information

NPI: 1457859316
Provider Name (Legal Business Name): SEREENA CREAMER LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 GOUGLER AVE
KENT OH
44240-2401
US

IV. Provider business mailing address

9217 STATE ROUTE 43
STREETSBORO OH
44241-5369
US

V. Phone/Fax

Practice location:
  • Phone: 330-631-3042
  • Fax:
Mailing address:
  • Phone: 330-422-9005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberE.1800868
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLMHC10002055
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10002055
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.1800868
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: