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General NPI Number Information
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NPI Number | 1649303512
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Entity Type | Organization
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Legal Business Name | WEST MOCK ASSOCIATES, INC DBA CENTER FOR INTERPERSONAL DEVELOPMENT
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 14650 DETROIT AVENUE SUITE LL40
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City | LAKEWOOD
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State | OH
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Zip | 44107
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Country | US
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Telephone | 216-226-2721
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Fax | 216-226-2731
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Provider Business Mailing Address
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Address Line | 14650 DETROIT AVENUE SUITE LL40
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City | LAKEWOOD
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State | OH
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Zip | 44107
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Country | US
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Telephone | 216-226-2721
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Fax | 216-226-2731
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. BARBARA S. SWIMMER
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Credential | LISW-S SAP
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Telephone | 216-226-2721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 3760
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 071029
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | I0031096
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License Number State | OH
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