Provider Demographics
NPI:1780815548
Name:THE COUNSELING AND EDUCATION CENTER OF STARK COUNTY, LLC
Entity Type:Organization
Organization Name:THE COUNSELING AND EDUCATION CENTER OF STARK COUNTY, LLC
Other - Org Name:THE COUNSELING AND EDUCATION CENTER OF STARK COUNTY, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:WILLIS
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:330-430-9535
Mailing Address - Street 1:1930 FULTON ROAD NORTH WEST SUITE 102
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44711
Mailing Address - Country:US
Mailing Address - Phone:330-430-9535
Mailing Address - Fax:330-430-9534
Practice Address - Street 1:1930 FULTON RD NW STE 102
Practice Address - Street 2:SUITE 102
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3526
Practice Address - Country:US
Practice Address - Phone:330-430-9535
Practice Address - Fax:330-430-9534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0005078251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1902829682Medicare UPIN