Provider Demographics
NPI:1982092474
Name:GHIORGHIE, SIMINA (EDS)
Entity Type:Individual
Prefix:
First Name:SIMINA
Middle Name:
Last Name:GHIORGHIE
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CREEKLEDGE LN
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-3238
Mailing Address - Country:US
Mailing Address - Phone:330-665-1610
Mailing Address - Fax:
Practice Address - Street 1:326 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3136
Practice Address - Country:US
Practice Address - Phone:330-297-1426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1352780103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool