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5500 Market St Ste 203 Boardman OH 44512-2624 | |
| (330) 330-8332 | |
| (234) 201-8390 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 5500 Market St Ste 203, Boardman, Ohio |
| Authorized Official Name and Position | Gloris A Griffin (OWNER) |
| Authorized Official Contact | 3306235387 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5500 Market St Ste 203 Boardman OH 44512-2624 Ph: (330) 330-8332 | 5500 Market St Ste 203 Boardman OH 44512-2624 Ph: (330) 330-8332 |
| NPI Number | 1629677166 |
|---|---|
| Provider Enumeration Date | 10/24/2020 |
| Last Update Date | 08/10/2024 |
| Certification Date | 08/10/2024 |
| Medicare PECOS PAC ID | 0244765287 |
|---|---|
| Medicare Enrollment ID | O20241127001142 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629677166 | NPI | - | NPPES |
| 0315372 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| 347C00000X | Private Vehicle | (* (Not Available)) | Secondary |
| Provider Name | Tadarrio J Lowery |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518405190 PECOS PAC ID: 7315470812 Enrollment ID: I20241022005048 |
| Provider Name | Dawn Powell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598917650 PECOS PAC ID: 5496280463 Enrollment ID: I20241127002271 |
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