Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | E. 0500701 SUPV | OH |
Y | 101YM0800X | Mental Health Counselor | E. 0500701 SUPV | OH |
N | 101YP1600X | Pastoral Counselor | E. 0500701 SUPV | OH |
N | 101YP2500X | Professional Counselor | E. 0500701 SUPV | OH |
NPI | 1215253109 |
---|---|
Provider Name | Edward E Dickerhoof |
First Address | Canton, OH 44718-2546 |
Second Address | Canton, OH 44718-2546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2010 |
Last Update Date | 29/07/2010 |