=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376982736
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOMESTIC VIOLENCE PROJECT, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2013
-----------------------------------------------------
Last Update Date | 06/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 19TH ST NE
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44714-2213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-491-1351
-----------------------------------------------------
Fax | 330-491-9720
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9459
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44711-9459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-445-2001
-----------------------------------------------------
Fax | 330-445-2007
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR/CEO
-----------------------------------------------------
Name | MS. MELISSA L PEARCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-445-2001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | 0705
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------