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General NPI Number Information
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NPI Number | 1679248215
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Entity Type | Organization
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Legal Business Name | PERSONAL SPACE: SELF CENTERING THERAPY
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 24100 CHAGRIN BLVD
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City | BEACHWOOD
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State | OH
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Zip | 44122-5535
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Country | US
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Telephone | 330-485-6202
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Fax |
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Provider Business Mailing Address
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Address Line | 12756 MILLSTREAM DR
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City | BOWIE
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State | MD
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Zip | 20715-1637
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Country | US
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Telephone | 330-485-6202
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SYMPHONIE D SMITH
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Credential |
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Telephone | 330-485-6202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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