Provider Demographics
NPI:1508332206
Name:EILAND, SERITA J (LPC-MA)
Entity Type:Individual
Prefix:
First Name:SERITA
Middle Name:J
Last Name:EILAND
Suffix:
Gender:F
Credentials:LPC-MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9453 VISTA CT
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-3601
Mailing Address - Country:US
Mailing Address - Phone:330-541-3207
Mailing Address - Fax:
Practice Address - Street 1:9205 STATE ROUTE 43 STE 210
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5367
Practice Address - Country:US
Practice Address - Phone:330-968-5976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2002954101YP2500X, 101YM0800X
OHC.1801334-TRNE251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0320375Medicaid