Healthcare Provider Details

I. General information

NPI: 1750154936
Provider Name (Legal Business Name): CUPPA COFFEE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 E 329TH ST
WILLOWICK OH
44095-3228
US

IV. Provider business mailing address

339 E 329TH ST
WILLOWICK OH
44095-3228
US

V. Phone/Fax

Practice location:
  • Phone: 440-201-9931
  • Fax:
Mailing address:
  • Phone: 440-201-9931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND MARSHALL JR.
Title or Position: OWNER/COUNSELOR
Credential: LPCC, CDCA
Phone: 440-201-9931