Provider Demographics
NPI:1326348517
Name:OLMSTEAD, SU-QIN YANG (CDCA)
Entity Type:Individual
Prefix:MRS
First Name:SU-QIN
Middle Name:YANG
Last Name:OLMSTEAD
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-5715
Mailing Address - Country:US
Mailing Address - Phone:330-372-2200
Mailing Address - Fax:
Practice Address - Street 1:430 FRANKLIN ST SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-5715
Practice Address - Country:US
Practice Address - Phone:330-372-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH090572101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)