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NPI Code Detail

MEDICARE: COMMUNITY COUNSELING CENTER OF ASHTABULA COUNTY

MEDICARE: COMMUNITY COUNSELING CENTER OF ASHTABULA COUNTY
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
1251B00000XCase Management Agency0166OH
2261QM0850XAdult Mental Health Clinic/Center0166OH
3261QM0855XAdolescent and Children Mental Health Clinic/Center0166OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720029622
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY COUNSELING CENTER OF ASHTABULA COUNTY
Provider Business Mailing Address
First Line : 2801 'C' COURT
Second Line :
City : ASHTABULA
State : OH
Zip : 44004
Country : US
Telephone Number : 440-998-4210
Fax Number : 440-998-2247
Provider Business Practice Location Address
First Line : 2801 C CT
Second Line :
City : ASHTABULA
State : OH
Zip : 44004-4577
Country : US
Telephone Number : 440-998-4210
Fax Number : 440-998-2247
Authorized Official
Title or Position : CEO
Name : MR. PAUL SAMUEL BOLINO
Credential : M.S,ED.,LPCC-S, CDCA
Telephone Number : 440-998-4210
Provider Enumeration Date : 06/10/2006
Last Update Date : 03/04/2015

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Directions to “COMMUNITY COUNSELING CENTER OF ASHTABULA COUNTY ” Practice Location

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