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General NPI Number Information
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NPI Number | 1154747061
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL COUNSELING
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Dates
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Enumeration Date | 03/16/2014
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Last Update Date | 03/16/2014
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Provider Practice Location Address
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Address Line | 10901 REED HARTMAN HWY SUITE #108
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City | BLUE ASH
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State | OH
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Zip | 45242-2831
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Country | US
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Telephone | 513-473-3110
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Fax |
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Provider Business Mailing Address
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Address Line | 10901 REED HARTMAN HWY SUITE #108
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City | BLUE ASH
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State | OH
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Zip | 45242-2831
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Country | US
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Telephone | 513-473-3110
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | LILLIE J MARTIN
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Credential | LISW-S
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Telephone | 513-242-4235
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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 | L.0003571
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License Number State | OH
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