Provider Demographics
NPI:1417927112
Name:TOLBERT, KATHLEEN M (LISW-S, CEAP, SAP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:LISW-S, CEAP, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6370 SOM CENTER ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139
Mailing Address - Country:US
Mailing Address - Phone:440-542-9877
Mailing Address - Fax:440-542-9879
Practice Address - Street 1:6370 SOM CENTER ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139
Practice Address - Country:US
Practice Address - Phone:440-542-9877
Practice Address - Fax:440-542-9879
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0005315101YA0400X, 104100000X, 1041C0700X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst