Provider Demographics
NPI:1821499633
Name:PERRY, NIESHA (LPCC-S,LICDC-CS)
Entity Type:Individual
Prefix:
First Name:NIESHA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LPCC-S,LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25401 CHATWORTH DR
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1841
Mailing Address - Country:US
Mailing Address - Phone:440-520-2524
Mailing Address - Fax:
Practice Address - Street 1:291 E 222ND ST # 205
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1718
Practice Address - Country:US
Practice Address - Phone:440-520-2524
Practice Address - Fax:216-273-7887
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00005940101YA0400X
OHE.1000564-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)