Healthcare Provider Details

I. General information

NPI: 1972843746
Provider Name (Legal Business Name): RAFIE STURGIS C.2103478
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5209 EUCLID AVE
CLEVELAND OH
44103-3703
US

IV. Provider business mailing address

5209 EUCLID AVE
CLEVELAND OH
44103-3703
US

V. Phone/Fax

Practice location:
  • Phone: 216-881-0765
  • Fax: 216-431-2190
Mailing address:
  • Phone: 216-881-0765
  • Fax: 216-431-2190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC.2103478
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2103478
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: