Provider Demographics
NPI:1427788868
Name:STORESINA, JADE AURORA
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:AURORA
Last Name:STORESINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 MEADOW VIEW DR NW
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-8695
Mailing Address - Country:US
Mailing Address - Phone:330-324-5773
Mailing Address - Fax:
Practice Address - Street 1:867 MEADOW VIEW DR NW
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-8695
Practice Address - Country:US
Practice Address - Phone:330-324-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.180164101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)