Provider Demographics
NPI:1306312905
Name:ANDERSON, CARA (LPC)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6693 N CHESTNUT ST STE 235
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3900
Mailing Address - Country:US
Mailing Address - Phone:330-296-3700
Mailing Address - Fax:330-298-1460
Practice Address - Street 1:6693 N CHESTNUT ST STE 235
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3900
Practice Address - Country:US
Practice Address - Phone:330-296-3700
Practice Address - Fax:330-298-1460
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801289101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH101YP2500XMedicaid