Healthcare Provider Details

I. General information

NPI: 1558926634
Provider Name (Legal Business Name): CARA IRWIN CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2019
Last Update Date: 03/17/2024
Certification Date: 03/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 E BROAD ST
COLUMBUS OH
43213-1064
US

IV. Provider business mailing address

841 STEUBENVILLE AVE
CAMBRIDGE OH
43725-2301
US

V. Phone/Fax

Practice location:
  • Phone: 614-334-6903
  • Fax:
Mailing address:
  • Phone: 855-692-7247
  • Fax: 855-692-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162293
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2207782
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: