MEDICARE: MR. CHARLES MICHAEL SABAKA LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	E0002100	OH

General Provider Information

NPI Number	:	1336253079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES MICHAEL SABAKA LPCC

Provider Business Mailing Address
First Line	:	129 34TH ST NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709
Country	:	US
Telephone Number	:	330-493-6291
Fax Number	:

Provider Business Practice Location Address
First Line	:	3118 CLEVELAND AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-2813
Country	:	US
Telephone Number	:	330-492-9913
Fax Number	:	330-492-6561

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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