Healthcare Provider Details

I. General information

NPI: 1972285336
Provider Name (Legal Business Name): DANA WILFORD CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 CARNEGIE AVE
CLEVELAND OH
44115-2641
US

IV. Provider business mailing address

13305 EDGEWOOD AVE
CLEVELAND OH
44105-4640
US

V. Phone/Fax

Practice location:
  • Phone: 216-424-7334
  • Fax:
Mailing address:
  • Phone: 216-424-7334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number190639
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number190639
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCDCA184700
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: