Provider Demographics
NPI:1689869653
Name:DICOLA, CHRISTINE M (PC)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:M
Last Name:DICOLA
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 TUSCARAWAS ST W
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4644
Mailing Address - Country:US
Mailing Address - Phone:330-452-7694
Mailing Address - Fax:330-452-7795
Practice Address - Street 1:2600 TUSCARAWAS ST W
Practice Address - Street 2:SUITE 120
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4644
Practice Address - Country:US
Practice Address - Phone:330-452-7694
Practice Address - Fax:330-452-7795
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0006693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health