Provider Demographics
NPI:1588080816
Name:FAMILY ALLIANCE COUNSELING LLC
Entity type:Organization
Organization Name:FAMILY ALLIANCE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:GINNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:440-787-5355
Mailing Address - Street 1:31674 CENTER RIDGE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-2401
Mailing Address - Country:US
Mailing Address - Phone:440-787-5355
Mailing Address - Fax:
Practice Address - Street 1:31674 CENTER RIDGE RD STE 204
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-2401
Practice Address - Country:US
Practice Address - Phone:440-787-5355
Practice Address - Fax:440-281-8978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2024-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.11010501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0155548Medicaid