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General NPI Number Information
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NPI Number | 1447346564
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Entity Type | Organization
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Legal Business Name | SOURCEONE GROUP INC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 01/14/2008
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Provider Practice Location Address
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Address Line | 210 E MILLTOWN RD SUITE B
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City | WOOSTER
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State | OH
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Zip | 44691-1246
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Country | US
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Telephone | 330-345-0955
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Fax | 330-345-3420
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Provider Business Mailing Address
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Address Line | 210 E MILLTOWN RD SUITE B
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City | WOOSTER
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State | OH
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Zip | 44691-1246
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Country | US
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Telephone | 330-345-0955
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Fax | 330-345-3420
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | SUSAN D. BUCHWALTER
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Credential | PH.D.
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Telephone | 330-345-0955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | OH
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