Basic Information
| Provider Information | |||||||||
| NPI: | 1063655884 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAREW | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | CHRISTINA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | NCCPCCSLICDCATRBC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 S COURT ST STE 5 | ||||||||
| Address2: | |||||||||
| City: | MEDINA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442562259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307237977 | ||||||||
| FaxNumber: | 3307255177 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 BELMONT AVE | ||||||||
| Address2: | |||||||||
| City: | YOUNGSTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445021039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307932487 | ||||||||
| FaxNumber: | 3307435748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2009 | ||||||||
| LastUpdateDate: | 05/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101Y00000X | E0007290 | OH | Y | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 081063 | OH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.