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General NPI Number Information
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NPI Number | 1366224768
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Entity Type | Organization
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Legal Business Name | TRIUMPH OVER TRAUMA
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Dates
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Enumeration Date | 10/19/2023
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Last Update Date | 10/27/2023
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Provider Practice Location Address
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Address Line | 9225 LINCOLN DR APT F10
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City | NORTHFIELD
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State | OH
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Zip | 44067-1155
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Country | US
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Telephone | 216-466-3675
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Fax |
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Provider Business Mailing Address
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Address Line | 9225 LINCOLN DR APT F10
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City | NORTHFIELD
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State | OH
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Zip | 44067-1155
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Country | US
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Telephone | 216-466-3675
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR/THERAPIST
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Name | JONETHA AASIMAH ALI
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Credential | LISW
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Telephone | 216-466-3675
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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 |
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License Number State |
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