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General NPI Number Information
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NPI Number | 1679792535
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Entity Type | Individual
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Provider Name | BARBARA J PACK LPCC-S, LICDC-CS
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Gender | Female
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 3484 AMHERST AVE NW
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City | MASSILLON
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State | OH
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Zip | 44646-1732
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Country | US
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Telephone | 330-575-8895
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Fax |
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Provider Business Mailing Address
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Address Line | 3484 AMHERST AVE NW
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City | MASSILLON
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State | OH
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Zip | 44646-1732
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Country | US
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Telephone | 330-575-8895
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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 | TPMC5148
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ICDC.011148 CS
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.0004203-SUPV
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License Number State | OH
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