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General NPI Number Information
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NPI Number | 1023481579
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Entity Type | Individual
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Provider Name | LAURA MARIE KIDD PC
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Gender | Female
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 1206 N MAIN ST
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City | NORTH CANTON
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State | OH
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Zip | 44720-1926
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Country | US
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Telephone | 330-433-2688
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Fax |
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Provider Business Mailing Address
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Address Line | 1666 13TH ST
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City | CUYAHOGA FALLS
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State | OH
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Zip | 44223-2306
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Country | US
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Telephone | 330-858-3531
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C.1400330
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License Number State | OH
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