Healthcare Provider Details

I. General information

NPI: 1386570786
Provider Name (Legal Business Name): WANDERING WILLOWS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 ROCKSIDE RD STE 322C
PARMA OH
44134-2749
US

IV. Provider business mailing address

4521 FRUITLAND DR
PARMA OH
44134-4534
US

V. Phone/Fax

Practice location:
  • Phone: 216-694-1285
  • Fax:
Mailing address:
  • Phone: 216-694-1285
  • Fax:

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: JILLIAN ANN DECARLO
Title or Position: OWNER/CLINICIAN
Credential: LPCC
Phone: 216-694-1285