Provider Demographics
NPI:1629430764
Name:FAUCETTE CHILD AND FAMILY COUNSELING, INC.
Entity Type:Organization
Organization Name:FAUCETTE CHILD AND FAMILY COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST, COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUCETTE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:330-542-6573
Mailing Address - Street 1:1350 5TH AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1765
Mailing Address - Country:US
Mailing Address - Phone:330-542-6573
Mailing Address - Fax:202-970-5606
Practice Address - Street 1:1350 5TH AVE STE 320
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1765
Practice Address - Country:US
Practice Address - Phone:330-542-6573
Practice Address - Fax:202-970-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0900303S101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1316247232OtherINDIVIDUAL NPI
OH0161000Medicaid
OHH284091Medicare UPIN
OH0161000Medicaid