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General NPI Number Information
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NPI Number | 1225479751
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Entity Type | Individual
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Provider Name | PETER MICHAEL DIMEZZA LPCC-SUPV
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Gender | Male
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Dates
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Enumeration Date | 07/12/2013
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Last Update Date | 06/20/2019
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Provider Practice Location Address
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Address Line | 1607 STATE RD STE 9
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City | VERMILION
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State | OH
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Zip | 44089
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Country | US
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Telephone | 440-967-7700
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Fax | 440-967-7701
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Provider Business Mailing Address
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Address Line | 1607 STATE RD STE 9
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City | VERMILION
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State | OH
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Zip | 44089-9142
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Country | US
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Telephone | 440-967-7700
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Fax | 440-967-7701
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E0002511-S
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License Number State | OH
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