Provider Demographics
NPI:1225479751
Name:DIMEZZA, PETER MICHAEL (LPCC-SUPV)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:DIMEZZA
Suffix:
Gender:M
Credentials:LPCC-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 STATE RD STE 9
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-9142
Mailing Address - Country:US
Mailing Address - Phone:440-967-7700
Mailing Address - Fax:440-967-7701
Practice Address - Street 1:1607 STATE RD STE 9
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089
Practice Address - Country:US
Practice Address - Phone:440-967-7700
Practice Address - Fax:440-967-7701
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0002511-S101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional