Healthcare Provider Details

I. General information

NPI: 1346177565
Provider Name (Legal Business Name): OLIVIA ANDREW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E MAIN ST STE A
RAVENNA OH
44266-3174
US

IV. Provider business mailing address

PO BOX 56
RAVENNA OH
44266-0056
US

V. Phone/Fax

Practice location:
  • Phone: 330-360-0543
  • Fax:
Mailing address:
  • Phone: 330-360-0543
  • 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: OLIVIA ANDREW
Title or Position: OWNER
Credential:
Phone: 330-360-0543