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Organization
RAVENWOOD MENTAL HEALTH CENTER
Active
Organization
RAVENWOOD MENTAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKI L CLARK LPCC-S, CEO (CEO)
(440) 285-2170
Entity
Organization
Contact information
Practice address
12557 RAVENWOOD DR, CHARDON, OH 44024-9009
(440) 285-2170
(440) 285-2207
Mailing address
12557 RAVENWOOD DR, CHARDON, OH 44024-9009
(440) 285-2170
(440) 285-2207
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053345975
NPI
OH
05
—
2863763
—
OH
Enumeration date
04/30/2012
Last updated
10/14/2014
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