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General NPI Number Information
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NPI Number | 1750520417
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL COUNSELING CENTER
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 3618 W MARKET ST
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City | FAIRLAWN
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State | OH
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Zip | 44333-2425
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Country | US
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Telephone | 330-815-0436
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Fax |
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Provider Business Mailing Address
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Address Line | 3618 W MARKET ST
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City | FAIRLAWN
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State | OH
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Zip | 44333-2425
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Country | US
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Telephone | 330-815-0436
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN J DAVIS
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Credential | PH.D.
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Telephone | 330-815-0436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 852
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License Number State | OH
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