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General NPI Number Information
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NPI Number | 1346402369
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Entity Type | Organization
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Legal Business Name | LAKESHORE EDUCATIONAL AND COUNSELING SERVICES
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 5475 LIBERTY AVE
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City | VERMILION
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State | OH
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Zip | 44089-1333
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Country | US
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Telephone | 440-963-0402
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Fax |
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Provider Business Mailing Address
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Address Line | 3212 BACH AVE APT 4
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City | CINCINNATI
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State | OH
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Zip | 45209-1756
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Country | US
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Telephone | 513-253-5137
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Fax |
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Authorized Official
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Title or Position | CHILD AND FAMILY THERAPIST
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Name | ANGELA F DOVER
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Credential | LPCC-S
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Telephone | 513-253-5137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | E.0008336-SUPV
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License Number State | OH
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