Provider Demographics
NPI:1063655884
Name:LAREW, HEIDI CHRISTINA (NCCPCCSLICDCATRBC)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:CHRISTINA
Last Name:LAREW
Suffix:
Gender:F
Credentials:NCCPCCSLICDCATRBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S COURT ST STE 5
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2259
Mailing Address - Country:US
Mailing Address - Phone:330-723-7977
Mailing Address - Fax:330-725-5177
Practice Address - Street 1:711 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-1039
Practice Address - Country:US
Practice Address - Phone:330-793-2487
Practice Address - Fax:330-743-5748
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OHE0007290101Y00000X
OH081063101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)