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General NPI Number Information
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NPI Number | 1972051647
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Entity Type | Organization
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Legal Business Name | THE STEVENS CENTER, LLC
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Dates
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Enumeration Date | 09/12/2016
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Last Update Date | 09/12/2016
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Provider Practice Location Address
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Address Line | 11925 PEARL RD SUITE 102
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City | STRONGSVILLE
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State | OH
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Zip | 44136-3353
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Country | US
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Telephone | 440-554-0670
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Fax |
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Provider Business Mailing Address
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Address Line | 11925 PEARL RD SUITE 102
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City | STRONGSVILLE
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State | OH
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Zip | 44136-3353
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Country | US
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Telephone | 440-554-0670
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Fax |
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR
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Name | MR. STEPHEN JARAMILLO
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Credential | LICDC-CS, LSW, SAP
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Telephone | 440-829-6281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 13995
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License Number State | OH
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