Individual
MISS BREANNA ROSE HEROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC-S, LICDC
Contact information
Practice address
3518 W 25TH ST, CLEVELAND, OH 44109-1951
(216) 741-2241
Mailing address
3518 W 25TH ST, CLEVELAND, OH 44109-1951
(330) 865-1841
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LICDC.181814
OH
101YM0800X
Mental Health Counselor
Primary
E.1700423-SUPV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0250090
—
OH
Enumeration date
02/25/2016
Last updated
10/11/2019
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