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NPI Code Detail

MEDICARE: FLORESTINE PLAIR LICDC

MEDICARE: FLORESTINE PLAIR LICDC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor101106OH

General Provider Information

NPI Number : 1417306234
Entity Type Code : Individual
Provider Name (Legal Business Name) : FLORESTINE PLAIR LICDC
Provider Business Mailing Address
First Line : 2202 PRAME AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1626
Country : US
Telephone Number : 216-377-1410
Fax Number : 216-472-3599
Provider Business Practice Location Address
First Line : 2121 W 117TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44111-1642
Country : US
Telephone Number : 216-417-4831
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2016
Last Update Date : 04/21/2023

Similar Medicare Providers

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1992302921 — NICOLE MARIE BENNETT CDCA.179664
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Directions to “ FLORESTINE PLAIR LICDC” Practice Location

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