Provider Demographics
NPI:1972093557
Name:COUNTRYMAN, KERI LEIGH (CDCA)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:LEIGH
Last Name:COUNTRYMAN
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1867 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6901
Mailing Address - Country:US
Mailing Address - Phone:330-812-3892
Mailing Address - Fax:
Practice Address - Street 1:1867 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-6901
Practice Address - Country:US
Practice Address - Phone:330-812-3892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)