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General NPI Number Information
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NPI Number | 1649594524
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Entity Type | Individual
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Provider Name | EILENE SHARON GOLUB LPCC, LICDC, LSW
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Gender | Female
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Dates
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Enumeration Date | 03/20/2010
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Last Update Date | 03/20/2010
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Provider Practice Location Address
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Address Line | 23761 BRYDEN RD
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City | BEACHWOOD
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State | OH
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Zip | 44122-4026
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Country | US
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Telephone | 216-831-4294
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Fax | 216-831-3943
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Provider Business Mailing Address
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Address Line | 23761 BRYDEN RD
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City | BEACHWOOD
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State | OH
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Zip | 44122-4026
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Country | US
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Telephone | 216-831-4294
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Fax | 216-831-3943
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 981155
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E0001956
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S0013448
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License Number State | OH
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