Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | C.1000180 | OH |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | C.1000180 | OH |
N | 101YM0800X | Mental Health Counselor | C.1000180 | OH |
N | 101YP1600X | Pastoral Counselor | C.1000180 | OH |
N | 101YP2500X | Professional Counselor | C.1000180 | OH |
NPI | 1124378062 |
---|---|
Provider Name | Linette Kay Graddic |
First Address | Cleveland Heights, OH 44118-5317 |
Second Address | Cleveland, OH 44120-2397 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2012 |
Last Update Date | 15/03/2019 |