Provider Demographics
NPI:1225247786
Name:PALLADIUM COUNSELING GROUP, INC.
Entity Type:Organization
Organization Name:PALLADIUM COUNSELING GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGGELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MSSA, LISW-S
Authorized Official - Phone:330-836-8370
Mailing Address - Street 1:3094 W MARKET ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3626
Mailing Address - Country:US
Mailing Address - Phone:330-836-8370
Mailing Address - Fax:330-836-8373
Practice Address - Street 1:3094 W MARKET ST
Practice Address - Street 2:SUITE 110
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3626
Practice Address - Country:US
Practice Address - Phone:330-836-8370
Practice Address - Fax:330-836-8373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00041361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty