=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558762021
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOROTHEA GENAE HARDRICK LPCC-S
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2014
-----------------------------------------------------
Last Update Date | 10/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3975 KENNETH DR
-----------------------------------------------------
City | ROOTSTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44272-9252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-850-5141
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 398 UNION ST
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44146-4569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-256-4697
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 1000185
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | E.1700280
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------