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1780281634

NPI Code Detail

MEDICARE: HEALING COURAGEOUSLY LLC

MEDICARE: HEALING COURAGEOUSLY LLC

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	101YP2500X	Professional Counselor
2	104100000X	Social Worker
3	106H00000X	Marriage & Family Therapist
4	251B00000X	Case Management Agency
5	261QM0855X	Adolescent and Children Mental Health Clinic/Center
6	251S00000X	Community/Behavioral Health Agency

Other Identifiers

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

General Provider Information

NPI Number	:	1780281634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING COURAGEOUSLY LLC

Provider Business Mailing Address
First Line	:	625 PINE VALLEY LN APT 201
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-7774
Country	:	US
Telephone Number	:	419-376-9377
Fax Number	:

Provider Business Practice Location Address
First Line	:	2602 NEBRASKA AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-3241
Country	:	US
Telephone Number	:	419-318-9121
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREA JO'LEA DAVIS
Credential	:
Telephone Number	:	419-376-9377

Provider Enumeration Date	:	10/05/2020
Last Update Date	:	02/11/2025

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Directions to “HEALING COURAGEOUSLY LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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