Healthcare Provider Details

I. General information

NPI: 1497640965
Provider Name (Legal Business Name): DOROTHY BURGESS CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 E BUCHTEL AVE
AKRON OH
44305-2338
US

IV. Provider business mailing address

885 E BUCHTEL AVE
AKRON OH
44305-2338
US

V. Phone/Fax

Practice location:
  • Phone: 330-535-8116
  • Fax:
Mailing address:
  • Phone: 330-535-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.191844
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: