Healthcare Provider Details

I. General information

NPI: 1497527154
Provider Name (Legal Business Name): CONSTANCE LAVERNE KNOWLTON CDCA, PRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CONNIE KNOWLTON CDCA,PRS

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 E 111TH ST
CLEVELAND OH
44106-1318
US

IV. Provider business mailing address

1444 E 111TH ST
CLEVELAND OH
44106-1318
US

V. Phone/Fax

Practice location:
  • Phone: 216-421-4956
  • Fax:
Mailing address:
  • Phone: 216-421-4956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.004527
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number184286
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberAPS.004527
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: