Provider Information for 1891174215
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ATHENA MCCAMAN LISW, LICDC
Sex: Female
NPI: 1891174215
Last Updated: 2021-10-18
Certification Date: 2021-10-18
Certification Date: 2021-10-18
Details
| Name | Value | ||||||||||||
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| NPI | 1891174215 | ||||||||||||
| Enumeration Date | 2015-05-19 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 7232 JUSTIN WAY MENTOR, OH 44060-4881 United States Phone: 440-578-8200 | Fax: | ||||||||||||
| Primary Practice Address | 7232 JUSTIN WAY MENTOR, OH 44060-4881 United States Phone: 440-578-8200 | Fax: | ||||||||||||
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