Healthcare Provider Details

I. General information

NPI: 1184416257
Provider Name (Legal Business Name): MARVIN DJEDJE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4661 BELPAR ST NW
CANTON OH
44718-3602
US

IV. Provider business mailing address

4661 BELPAR ST NW
CANTON OH
44718-3602
US

V. Phone/Fax

Practice location:
  • Phone: 330-492-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: