Provider Demographics
NPI:1376982736
Name:DOMESTIC VIOLENCE PROJECT, INC
Entity Type:Organization
Organization Name:DOMESTIC VIOLENCE PROJECT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-445-2001
Mailing Address - Street 1:PO BOX 9459
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44711-9459
Mailing Address - Country:US
Mailing Address - Phone:330-445-2001
Mailing Address - Fax:330-445-2007
Practice Address - Street 1:720 19TH ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-2213
Practice Address - Country:US
Practice Address - Phone:330-491-1351
Practice Address - Fax:330-491-9720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0705261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1639146095Medicaid
OH6694Medicare UPIN