Provider Demographics
NPI:1154053619
Name:COONTZ, OLIVIA M (CDCA, QMHS)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:M
Last Name:COONTZ
Suffix:
Gender:F
Credentials:CDCA, QMHS
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:MADISON
Other - Last Name:COONTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:711 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502-1039
Mailing Address - Country:US
Mailing Address - Phone:330-793-2487
Mailing Address - Fax:330-743-5748
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?:No
Enumeration Date:2022-06-24
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.183194101YA0400X
OH172V00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker