=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043826027
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER OF HEALING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2020
-----------------------------------------------------
Last Update Date | 09/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 292 GREENSFIELD LN
-----------------------------------------------------
City | COPLEY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44321-3098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-689-9929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 292 GREENSFIELD LN
-----------------------------------------------------
City | COPLEY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44321-3098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-689-9929
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. ALISHA DENNIS-BRINSON
-----------------------------------------------------
Credential | LPCC-S, LICDC-CS
-----------------------------------------------------
Telephone | 330-689-9929
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------