Individual
CAROLYN DENISE GENTRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2151 RUSH BLVD, YOUNGSTOWN, OH 44507-1535
(330) 744-1181
Mailing address
146 SAYERS AVE, NILES, OH 44446-1725
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.165128
OH
175T00000X
Peer Specialist
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0282408
—
OH
Enumeration date
05/07/2018
Last updated
01/27/2021
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