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Organization

U1ST

Active
Organization subpart
No

Provider details

NPI number
Authorized official
EBONIE BOURGOIN (OWNER)
(330) 853-8627
Entity
Organization

Contact information

Practice address
3118 WILLIAMSBURG ST NW, WARREN, OH 44485-2255
(330) 853-8627
Mailing address
3118 WILLIAMSBURG ST NW, WARREN, OH 44485-2255
(330) 853-8627

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary

Other

Enumeration date
11/26/2025
Last updated
11/26/2025
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