1528615960 NPI number — ROSE-SHARON MILETIC MA, LPCC

Table of content: ROSE-SHARON MILETIC MA, LPCC (NPI 1528615960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528615960 NPI number — ROSE-SHARON MILETIC MA, LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILETIC
Provider First Name:
ROSE-SHARON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528615960
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
INSIGHT CLINICAL COUNSELING AND WELLNESS LLC
Provider Second Line Business Mailing Address:
45875 BELL SCHOOL RD STE B, EAST LIVERPOOL, OH 43920
Provider Business Mailing Address City Name:
EAST LIVERPOOL
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
234-999-1913
Provider Business Mailing Address Fax Number:
234-999-7297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45875 BELL SCHOOL RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LIVERPOOL
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43920-8728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-397-6007
Provider Business Practice Location Address Fax Number:
234-254-5655
Provider Enumeration Date:
08/21/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  C.1902172 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: E.2203246 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0365889 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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