Healthcare Provider Details

I. General information

NPI: 1376481440
Provider Name (Legal Business Name): DETELIN WILLIAM CASHMAN CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 MONTROSE WEST AVE
COPLEY OH
44321-3121
US

IV. Provider business mailing address

1221 MANITOULIN PIKE
BRUNSWICK OH
44212-2824
US

V. Phone/Fax

Practice location:
  • Phone: 330-993-4946
  • Fax:
Mailing address:
  • Phone: 216-390-5427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA193856
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: