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General NPI Number Information
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NPI Number | 1154740173
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Entity Type | Organization
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Legal Business Name | CONNECTIONS FAMILY COUNSELING LLC
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Dates
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Enumeration Date | 04/08/2014
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Last Update Date | 04/08/2014
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Provider Practice Location Address
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Address Line | 799 N COURT ST SUITE 3
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City | MEDINA
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State | OH
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Zip | 44256-1765
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Country | US
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Telephone | 330-722-0990
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Fax |
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Provider Business Mailing Address
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Address Line | 6085 BALLOU RD
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City | MEDINA
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State | OH
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Zip | 44256-9116
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Country | US
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Telephone | 330-321-2991
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARLA EVERSTIJN
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Credential |
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Telephone | 330-321-2991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I-8377-S
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License Number State | OH
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