UPI (Provider ID): 3392
Change Report (if Any):

Short Name: COM COUNSEL-ASH

Long Name 1: COMMUNITY COUNSELING CENTER
Long Name 2: OF ASHTABULA COUNTY

Address 1: 2801 C COURT
Address 2:

City: ASHTABULA
Zip Code: 44004
County: ASHT

Contact: STEVE CERVAS
Title: DIR
Phone: 4409984210
FAX: 4409986489

Vendor: 3392

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/08/2011

File Produced: 19MAY2012