Provider Demographics
NPI:1912723446
Name:GRASTA, GINA (EDM)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:GRASTA
Suffix:
Gender:F
Credentials:EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8672 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-1527
Mailing Address - Country:US
Mailing Address - Phone:585-545-8133
Mailing Address - Fax:
Practice Address - Street 1:8672 OXFORD DR
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44149-1527
Practice Address - Country:US
Practice Address - Phone:585-545-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-30
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH22441730101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool