Provider Demographics
NPI:1144979147
Name:AGAPE COUNSELING AND CONSULTING
Entity type:Organization
Organization Name:AGAPE COUNSELING AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:POPIK
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LICDC, LSW
Authorized Official - Phone:440-839-6037
Mailing Address - Street 1:26965 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-4044
Mailing Address - Country:US
Mailing Address - Phone:440-839-6037
Mailing Address - Fax:866-244-0657
Practice Address - Street 1:26965 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4044
Practice Address - Country:US
Practice Address - Phone:440-839-6037
Practice Address - Fax:866-244-0657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0287137Medicaid