Individual
AMY E PENDERGRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
3575 FOREST LAKE DR STE 100, GREEN, OH 44685-8115
(330) 703-0105
Mailing address
3575 FOREST LAKE DR STE 100, GREEN, OH 44685-8115
(330) 703-0105
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
C2002216TRNE
OH
101YM0800X
Mental Health Counselor
Primary
C.2103215
OH
101YM0800X
Mental Health Counselor
Primary
E.2606161
OH
Other
Enumeration date
01/28/2020
Last updated
01/14/2026
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