Individual
DEJAH M SPROUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1295 IDLEWOOD AVE, LAKEWOOD, OH 44107-2901
(440) 420-9584
Mailing address
1295 IDLEWOOD AVE, LAKEWOOD, OH 44107-2901
(440) 420-9584
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C.2304859
OH
171M00000X
Case Manager/Care Coordinator
—
OH
172V00000X
Community Health Worker
—
OH
Other
Enumeration date
05/04/2020
Last updated
02/21/2023
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