Basic Information
| Provider Information | |||||||||
| NPI: | 1275142838 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOC | ||||||||
| FirstName: | KAROLINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 481 TOLLIS PKWY APT 170E | ||||||||
| Address2: | |||||||||
| City: | BROADVIEW HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441471823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4406655777 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10427 DETROIT AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441021645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165216511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2020 | ||||||||
| LastUpdateDate: | 07/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C.2002635 | OH | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | CDCA.173788 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.