Provider Demographics
NPI:1639594195
Name:FAUCETTE CHILD & FAMILY COUNSELING
Entity Type:Organization
Organization Name:FAUCETTE CHILD & FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUCETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LISW-S, LBS
Authorized Official - Phone:330-318-3436
Mailing Address - Street 1:3212 MAHONING AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509
Mailing Address - Country:US
Mailing Address - Phone:330-318-3436
Mailing Address - Fax:330-319-8800
Practice Address - Street 1:3212 MAHONING AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-2600
Practice Address - Country:US
Practice Address - Phone:330-318-3436
Practice Address - Fax:330-319-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0900303251S00000X
PABH001192251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health