Healthcare Provider Details

I. General information

NPI: 1528421252
Provider Name (Legal Business Name): NEO COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9930 JOHNNYCAKE RIDGE RD STE 4F
MENTOR OH
44060-6762
US

IV. Provider business mailing address

9930 JOHNNYCAKE RIDGE RD STE 4F
MENTOR OH
44060-6762
US

V. Phone/Fax

Practice location:
  • Phone: 440-579-5100
  • Fax: 440-579-5104
Mailing address:
  • Phone: 440-579-5100
  • Fax: 440-579-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE1000347
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KATIE MARCHINCHIN
Title or Position: OWNER
Credential: M.A., P.C.C
Phone: 404-527-8006