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General NPI Number Information
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NPI Number | 1235354473
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Entity Type | Organization
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Legal Business Name | TOTAL CARE PSYCHOLOGICAL & COUNSELING SERVICES INC
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Dates
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Enumeration Date | 04/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5500 MARKET ST SUITE 90
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-2601
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Country | US
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Telephone | 330-782-7701
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Fax | 330-782-8785
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Provider Business Mailing Address
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Address Line | 5500 MARKET ST SUITE 90
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-2601
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Country | US
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Telephone | 330-782-7701
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Fax | 330-782-8785
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. MARY NEWELL WALLER
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Credential | PHD
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Telephone | 330-782-7701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4312
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License Number State | OH
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