Healthcare Provider Details

I. General information

NPI: 1508777343
Provider Name (Legal Business Name): AMYDAVIDLPCCLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7312 RACCOON HILL DR
KIRTLAND OH
44094-9737
US

IV. Provider business mailing address

7312 RACCOON HILL DR
KIRTLAND OH
44094-9737
US

V. Phone/Fax

Practice location:
  • Phone: 440-477-2513
  • Fax:
Mailing address:
  • Phone: 440-477-2513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. AMY S DAVID
Title or Position: THERAPIST
Credential: MA, LSW, LPCC
Phone: 440-477-2513