Healthcare Provider Details

I. General information

NPI: 1548783426
Provider Name (Legal Business Name): ALBERT PRIDE JR. LICDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 EAST 55TH STREET
CLEVELAND OH
44103
US

IV. Provider business mailing address

885 E BUCHTEL AVE
AKRON OH
44305-2338
US

V. Phone/Fax

Practice location:
  • Phone: 216-417-4213
  • Fax: 216-938-8965
Mailing address:
  • Phone: 330-535-8116
  • Fax: 330-996-2233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number161507
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: