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General NPI Number Information
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NPI Number | 1073408787
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Entity Type | Individual
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Provider Name | ERIKA PROVENCIO LPC
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Gender | Female
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 22639 EUCLID AVE
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City | EUCLID
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State | OH
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Zip | 44117-1622
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Country | US
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Telephone | 216-404-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 2310 OHIO AVE APT 149
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City | CINCINNATI
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State | OH
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Zip | 45219-1628
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Country | US
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Telephone | 505-967-7209
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | C.2406427
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License Number State | OH
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