Healthcare Provider Details

I. General information

NPI: 1629430764
Provider Name (Legal Business Name): FAUCETTE CHILD AND FAMILY COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 5TH AVE STE 320
YOUNGSTOWN OH
44504-1765
US

IV. Provider business mailing address

1350 5TH AVE STE 320
YOUNGSTOWN OH
44504-1765
US

V. Phone/Fax

Practice location:
  • Phone: 330-542-6573
  • Fax: 202-970-5606
Mailing address:
  • Phone: 330-542-6573
  • Fax: 202-970-5606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI0900303S
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberI0900303S
License Number StateOH

VIII. Authorized Official

Name: CAROLYN FAUCETTE
Title or Position: PSYCHOTHERAPIST, COUNSELOR
Credential: LISW-S
Phone: 330-542-6573