Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | C.2203765-TRNE | OH |
NPI | 1003222423 |
---|---|
Provider Name | Shea Kvachuk |
First Address | Blue Ash, OH 45242-2851 |
Second Address | Blue Ash, OH 45242-2851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2014 |
Last Update Date | 14/01/2022 |