Provider Demographics
NPI:1689074023
Name:EXODUS CLINICAL COUNSELING SERVICES(CCS)
Entity Type:Organization
Organization Name:EXODUS CLINICAL COUNSELING SERVICES(CCS)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC CLINICAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LARKINS
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LCDCIII
Authorized Official - Phone:440-516-0281
Mailing Address - Street 1:30841 EUCLID AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-3100
Mailing Address - Country:US
Mailing Address - Phone:440-516-0281
Mailing Address - Fax:
Practice Address - Street 1:30841 EUCLID AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-3100
Practice Address - Country:US
Practice Address - Phone:440-516-0281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH081194101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1386961910OtherNPI