Provider Demographics
NPI:1790842862
Name:GINNIS, LANA KIRK (LISW)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:KIRK
Last Name:GINNIS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21403 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5322
Mailing Address - Country:US
Mailing Address - Phone:216-991-2707
Mailing Address - Fax:
Practice Address - Street 1:21403 CHAGRIN BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5322
Practice Address - Country:US
Practice Address - Phone:216-991-2707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 00009001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical