Healthcare Provider Details

I. General information

NPI: 1518484286
Provider Name (Legal Business Name): PHYLISSA DAQUINO LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 SILVER ST
KENTON OH
43326-1499
US

IV. Provider business mailing address

329 N WEST ST
LIMA OH
45801-4332
US

V. Phone/Fax

Practice location:
  • Phone: 419-673-7248
  • Fax:
Mailing address:
  • Phone: 419-221-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2203068
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: