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General NPI Number Information
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NPI Number | 1699301234
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Entity Type | Organization
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Legal Business Name | COLLABORATIVE COUNSELING
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Dates
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Enumeration Date | 03/16/2020
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 10623 SOUTH ST
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City | GARRETTSVILLE
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State | OH
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Zip | 44231-1108
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Country | US
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Telephone | 330-398-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 12066 PRENTISS RD
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City | GARRETTSVILLE
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State | OH
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Zip | 44231-9694
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUDITH BERNADETTE MACEK
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Credential | LPCC
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Telephone | 330-398-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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