Provider Demographics
NPI:1821869355
Name:EGNACHESKI, KARISSA LOUISE
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:LOUISE
Last Name:EGNACHESKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:LOISE
Other - Last Name:KUNELI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 ORIOLE DR
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-2618
Mailing Address - Country:US
Mailing Address - Phone:330-469-3636
Mailing Address - Fax:
Practice Address - Street 1:1920 CHURCHILL RD STE 200
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-2484
Practice Address - Country:US
Practice Address - Phone:330-932-4002
Practice Address - Fax:330-932-4004
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2405476-TRNE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor