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Diane Fultz, LCDCII, SWA, QMHS

Counselor, Addiction (Substance Use Disorder) in Mentor, OH. Individual provider (NPI-1).

NPI number1780197756
StatusActive
Last updated in NPPESOct 24, 2021

Details

NPI
1780197756
Entity type
Individual (NPI-1)
Name
Diane Fultz
Credential
LCDCII, SWA, QMHS
Sex
Female
Sole proprietor
Yes
Enumeration date
Nov 13, 2017
Certification date
Oct 24, 2021
Last updated
Oct 24, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
101YA0400X Counselor, Addiction (Substance Use Disorder)LCDCII.161560OHYes
171M00000X Case Manager/Care CoordinatorW.1300044OH

Practice location

7232 Justin Way
Mentor, OH 44060-4881

Phone 440-578-8200

Mailing address

7232 Justin Way
Mentor, OH 44060-4881

Phone 440-578-8200

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Other Addiction (Substance Use Disorder) Counselor providers in Mentor, OH

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