Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | E.1800746 | OH |
N | 101YP2500X | Professional Counselor | E.1800746 | OH |
NPI | 1003420076 |
---|---|
Provider Name | Theresa Gill |
First Address | Mentor, OH 44060-4881 |
Second Address | Mentor, OH 44060-4881 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2020 |
Last Update Date | 11/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0416997 | (05) | OH |