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General NPI Number Information
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NPI Number | 1346780137
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Entity Type | Organization
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Legal Business Name | FAMILY AND INDIVIDUAL THERAPEUTIC HEALING LLC
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 1145 TALL GRASS CIR #202
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City | STOW
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State | OH
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Zip | 44224-6936
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Country | US
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Telephone | 330-280-0716
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Fax |
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Provider Business Mailing Address
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Address Line | 3926 CLOCK POINTE TRL SUITE 103
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City | STOW
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State | OH
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Zip | 44224-6965
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Country | US
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Telephone | 330-529-2002
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Fax | 330-529-2002
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Authorized Official
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Title or Position | OWNER
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Name | DR. LISA MARIE GIOVANNELLI
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Credential | PHD
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Telephone | 330-280-0716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 011296
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | E0800007SUPV
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License Number State | OH
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