Individual
MS. LISA ANN KOSTANSEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PCC-S, LCDC III
Contact information
Practice address
8445 MUNSON RD, MENTOR, OH 44060-2410
(440) 255-1700
(440) 205-2417
Mailing address
10454 STONE RIDGE DR, KIRTLAND, OH 44094-8748
(440) 256-3246
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
050505
OH
101YM0800X
Mental Health Counselor
E0003136
OH
101YP2500X
Professional Counselor
Primary
E003136
OH
Other
Enumeration date
02/27/2007
Last updated
08/06/2008
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