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General NPI Number Information
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NPI Number | 1508332206
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Entity Type | Individual
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Provider Name | SERITA J EILAND LPC-MA
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Gender | Female
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Dates
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Enumeration Date | 10/19/2018
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 9205 STATE ROUTE 43 STE 210
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City | STREETSBORO
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State | OH
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Zip | 44241-5367
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Country | US
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Telephone | 330-968-5976
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Fax |
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Provider Business Mailing Address
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Address Line | 9453 VISTA CT
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City | STREETSBORO
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State | OH
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Zip | 44241-3601
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Country | US
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Telephone | 330-541-3207
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C.2002954
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | C.1801334-TRNE
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.2002954
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License Number State | OH
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