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General NPI Number Information
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NPI Number | 1215099866
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Entity Type | Organization
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Legal Business Name | COMPASS RECOVERY
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 109 E MAIN ST
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City | RAVENNA
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State | OH
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Zip | 44266-3101
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Country | US
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Telephone | 330-298-9391
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Fax | 330-298-9392
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Provider Business Mailing Address
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Address Line | 3925 S PRICETOWN RD
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City | BERLIN CENTER
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State | OH
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Zip | 44401-8700
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Country | US
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Telephone | 330-298-9391
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Fax | 330-292-9392
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Authorized Official
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Title or Position | CHEMICAL DEPENDENCY COUNSELOR
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Name | MS. VICKI LYNNE PELLETIER
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Credential | LSW, MSSA, JD
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Telephone | 330-298-9391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S0031295
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License Number State | OH
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