Provider Demographics
NPI:1093228207
Name:SKORICH, GINA M (LISW LICDC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:SKORICH
Suffix:
Gender:F
Credentials:LISW LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1281 E 360TH ST
Mailing Address - Street 2:
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095-3130
Mailing Address - Country:US
Mailing Address - Phone:440-269-0826
Mailing Address - Fax:
Practice Address - Street 1:9113 KATHERINE CT
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-1643
Practice Address - Country:US
Practice Address - Phone:216-466-1423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161964101YA0400X
OHI.2405690104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)