Healthcare Provider Details

I. General information

NPI: 1063655884
Provider Name (Legal Business Name): HEIDI CHRISTINA LAREW NCCPCCSLICDCATRBC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 BELMONT AVE
YOUNGSTOWN OH
44502-1039
US

IV. Provider business mailing address

230 S COURT ST STE 5
MEDINA OH
44256-2259
US

V. Phone/Fax

Practice location:
  • Phone: 330-793-2487
  • Fax: 330-743-5748
Mailing address:
  • Phone: 330-723-7977
  • Fax: 330-725-5177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE0007290
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number081063
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: