Healthcare Provider Details

I. General information

NPI: 1225253107
Provider Name (Legal Business Name): AVENUES OF COUNSELING AND MEDIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S COURT ST SUITE 5
MEDINA OH
44256-2259
US

IV. Provider business mailing address

230 S COURT ST SUITE 5
MEDINA OH
44256-2259
US

V. Phone/Fax

Practice location:
  • Phone: 330-723-7977
  • Fax: 330-725-5177
Mailing address:
  • Phone: 330-723-7977
  • Fax: 330-725-5177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LISA BORCHERT-HRIVNAK
Title or Position: OWNER
Credential: M.A.ED., LPCC
Phone: 330-723-7977