Healthcare Provider Details

I. General information

NPI: 1871417550
Provider Name (Legal Business Name): DEQUILTA R COSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 HAMMEL ST
AKRON OH
44306-2255
US

IV. Provider business mailing address

971 HAMMEL ST
AKRON OH
44306-2255
US

V. Phone/Fax

Practice location:
  • Phone: 234-817-9575
  • Fax:
Mailing address:
  • Phone: 234-817-9575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number195074
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: