Individual
CHRISTINE MARIE POLGAR FAWCETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW, LICDC
Contact information
Practice address
1710 AMBERLEY AVE, CLEVELAND, OH 44109-3508
(216) 577-8568
Mailing address
1710 AMBERLEY AVE, CLEVELAND, OH 44109-3508
(216) 577-8568
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
150720
OH
101YP2500X
Professional Counselor
Primary
LICDC.162168
OH
104100000X
Social Worker
S1701513
OH
Other
Enumeration date
01/25/2016
Last updated
10/17/2024
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