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General NPI Number Information
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NPI Number | 1467916809
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Entity Type | Organization
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Legal Business Name | INTER-CEPT CONSULTANT SERVICES, LLC
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Dates
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Enumeration Date | 01/30/2019
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 13303 BEACHWOOD AVE
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City | CLEVELAND
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State | OH
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Zip | 44105-6415
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Country | US
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Telephone | 216-581-1662
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Fax | 216-581-4540
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Provider Business Mailing Address
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Address Line | 13303 BEACHWOOD AVE
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City | CLEVELAND
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State | OH
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Zip | 44105-6415
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Country | US
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Telephone | 216-581-1662
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Fax | 216-581-4540
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Authorized Official
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Title or Position | CEO
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Name | CYNTHIA MILLER
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Credential | LICDC-CS
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Telephone | 216-402-0684
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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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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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