Provider Demographics
NPI:1801343520
Name:SMALL, TAKIYAH G (LPCC)
Entity type:Individual
Prefix:MRS
First Name:TAKIYAH
Middle Name:G
Last Name:SMALL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2556 DURAND RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3835
Mailing Address - Country:US
Mailing Address - Phone:330-338-1308
Mailing Address - Fax:
Practice Address - Street 1:18 N FORGE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304
Practice Address - Country:US
Practice Address - Phone:330-762-0591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-10
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1600224-TRNE101Y00000X
101YP2500X
OHC.1700349101YP2500X
OHE.1901565101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor