Tina M Lake, LSW

NPI #1164901054 in Massillon, Ohio

Provider Information

NPI Number: 1164901054
Entity Type: Individual
Name: Tina M Lake, LSW
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Social Worker
Credential: LSW
Enumeration Date: Aug 10, 2018
Last Updated: Aug 10, 2018

Practice Location

Address: 1660 NAVE RD SE
City: Massillon
State: Ohio
ZIP Code: 44646-9604
Phone: (330) 837-9411

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder)	101YA0400X
Social Worker	104100000X	Primary

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