Provider Demographics
NPI:1689682007
Name:CHINTAN, DHARL (LSW)
Entity Type:Individual
Prefix:MR
First Name:DHARL
Middle Name:
Last Name:CHINTAN
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 LOGAN WAY
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-3311
Mailing Address - Country:US
Mailing Address - Phone:330-716-5144
Mailing Address - Fax:330-259-3665
Practice Address - Street 1:4505 LOGAN WAY
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-3311
Practice Address - Country:US
Practice Address - Phone:330-716-5144
Practice Address - Fax:330-259-3665
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0003655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health