Individual
KEVIN FASIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC-S, LICDC
Contact information
Practice address
246 NORTHLAND DR STE 200A, MEDINA, OH 44256-3440
(330) 725-9195
(330) 725-9187
Mailing address
246 NORTHLAND DR STE 200A, MEDINA, OH 44256-3440
(330) 725-9195
(330) 725-9187
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LICDC.161660
OH
101YP2500X
Professional Counselor
Primary
E.1300003-SUPV
OH
101YP2500X
Professional Counselor
LE-00019042
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0181362
—
OH
Enumeration date
08/21/2012
Last updated
03/26/2020
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