Healthcare Provider Details

I. General information

NPI: 1902102346
Provider Name (Legal Business Name): AMY R DOROD-GAUL M.ED, LPCC-SUPV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35010 CHARDON RD STE 103
WILLOUGHBY HILLS OH
44094-9011
US

IV. Provider business mailing address

35010 CHARDON RD STE 103
WILLOUGHBY HILLS OH
44094-9011
US

V. Phone/Fax

Practice location:
  • Phone: 440-597-2517
  • Fax:
Mailing address:
  • Phone: 440-597-2517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0900128-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: