Basic Information
| Provider Information | |||||||||
| NPI: | 1336348481 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLITE | ||||||||
| FirstName: | DOROTHEA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | MSED, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2531 OHIO AVE | ||||||||
| Address2: | |||||||||
| City: | YOUNGSTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445041832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307276470 | ||||||||
| FaxNumber: | 3307463449 | ||||||||
| Practice Location | |||||||||
| Address1: | 611 BELMONT AVE | ||||||||
| Address2: | |||||||||
| City: | YOUNGSTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445021037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307442991 | ||||||||
| FaxNumber: | 3307463449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2007 | ||||||||
| LastUpdateDate: | 07/17/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C0005399 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.