Healthcare Provider Details

I. General information

NPI: 1750885331
Provider Name (Legal Business Name): ASHLEY CHRISTINE ALLISON CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 BOARDMAN CANFIELD RD
BOARDMAN OH
44512-4218
US

IV. Provider business mailing address

102 WESTCHESTER DR
AUSTINTOWN OH
44515-3963
US

V. Phone/Fax

Practice location:
  • Phone: 330-953-3402
  • Fax:
Mailing address:
  • Phone: 330-270-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: