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General NPI Number Information
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NPI Number | 1902513690
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Entity Type | Organization
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Legal Business Name | THE CONNECTED COUNSELOR
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Dates
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Enumeration Date | 11/01/2022
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 2189 PROFESSOR AVE
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City | CLEVELAND
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State | OH
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Zip | 44113-3634
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Country | US
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Telephone | 216-505-0959
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Fax |
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Provider Business Mailing Address
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Address Line | 2189 PROFESSOR AVE
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City | CLEVELAND
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State | OH
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Zip | 44113-3634
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Country | US
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Telephone | 216-505-0959
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED AGENT
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Name | MR. CARL POYTHRESS
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Credential | NA
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Telephone | 216-645-2746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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