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General NPI Number Information
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NPI Number | 1538695556
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Entity Type | Individual
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Provider Name | RENEE ANDREA POPOVIC L.P.C., M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 16903 FISCHER RD
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City | LAKEWOOD
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State | OH
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Zip | 44107-5577
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Country | US
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Telephone | 216-302-7804
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Fax |
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Provider Business Mailing Address
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Address Line | 9207 CLIFTON BLVD
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City | CLEVELAND
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State | OH
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Zip | 44102-1607
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Country | US
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Telephone | 216-254-5839
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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.1400492
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License Number State | OH
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