Provider Demographics
NPI:1063194637
Name:LINDSEY RAINBOW COUNSELING CENTER
Entity type:Organization
Organization Name:LINDSEY RAINBOW COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAQUITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LSW
Authorized Official - Phone:216-299-1305
Mailing Address - Street 1:19530 TELBIR AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-2622
Mailing Address - Country:US
Mailing Address - Phone:216-299-1305
Mailing Address - Fax:
Practice Address - Street 1:19530 TELBIR AVE
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-2622
Practice Address - Country:US
Practice Address - Phone:216-299-1305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health