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General NPI Number Information
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NPI Number | 1912385691
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS COUNSELING CENTER
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Dates
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Enumeration Date | 05/13/2015
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 140 WADSWORTH RD
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City | WADSWORTH
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State | OH
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Zip | 44281-9503
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Country | US
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Telephone | 440-390-8384
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Fax |
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Provider Business Mailing Address
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Address Line | 140 WADSWORTH RD
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City | WADSWORTH
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State | OH
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Zip | 44281-9503
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Country | US
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Telephone | 440-390-8384
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Fax |
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | KATIE WOOTTON
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Credential |
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Telephone | 440-390-8384
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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 | 1100354
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1500008
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License Number State | OH
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