Provider Demographics
NPI:1366203382
Name:MENDOLA, PHILIP (LPC)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:MENDOLA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 MANNING PKWY
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9171
Mailing Address - Country:US
Mailing Address - Phone:614-888-9200
Mailing Address - Fax:614-888-3239
Practice Address - Street 1:1480 MANNING PKWY
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9171
Practice Address - Country:US
Practice Address - Phone:614-888-9200
Practice Address - Fax:614-888-3239
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2405757101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health