Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | E1400102-SUPV | OH |
N | 101YM0800X | Mental Health Counselor | LE00028548 | OH |
N | 101YP2500X | Professional Counselor | C1400102 | OH |
NPI | 1003232406 |
---|---|
Provider Name | Nicole Gruszewski |
First Address | Barberton, OH 44203-2580 |
Second Address | Barberton, OH 44203-2580 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2014 |
Last Update Date | 22/08/2019 |