Healthcare Provider Details

I. General information

NPI: 1881177004
Provider Name (Legal Business Name): ALLISON VANDRAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38500 CHARDON RD STE F
WILLOUGHBY HILLS OH
44094-8745
US

IV. Provider business mailing address

38500 CHARDON RD STE F
WILLOUGHBY HILLS OH
44094-8745
US

V. Phone/Fax

Practice location:
  • Phone: 440-305-5890
  • Fax: 440-205-1009
Mailing address:
  • Phone: 440-305-5890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2303441
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: