Provider Demographics
NPI:1548884349
Name:CARVE YOUR OWN PATH, INC.
Entity type:Organization
Organization Name:CARVE YOUR OWN PATH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSTURA
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:440-426-7885
Mailing Address - Street 1:840 ROTHROCK RD STE 203
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-3133
Mailing Address - Country:US
Mailing Address - Phone:330-426-7885
Mailing Address - Fax:
Practice Address - Street 1:840 ROTHROCK RD STE 203
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-3133
Practice Address - Country:US
Practice Address - Phone:330-426-7885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty