Individual
DIANE M WAKELEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PCC-S, LICDC
Contact information
Practice address
8351 MENTOR AVE, MENTOR, OH 44060-5749
(216) 839-2273
(216) 896-0735
Mailing address
11106 KIMMERIDGE TRL, #4B, NEWBURY, OH 44065-9683
(216) 288-6223
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
933513
OH
101YM0800X
Mental Health Counselor
Primary
E-1976
OH
Other
Enumeration date
02/25/2007
Last updated
08/17/2009
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