Healthcare Provider Details

I. General information

NPI: 1558903310
Provider Name (Legal Business Name): JOHN NORTHCOTT CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 GRISWOLD RD
ELYRIA OH
44035-2304
US

IV. Provider business mailing address

457 GRISWOLD RD
ELYRIA OH
44035-2304
US

V. Phone/Fax

Practice location:
  • Phone: 440-406-8006
  • Fax:
Mailing address:
  • Phone: 440-406-8006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number171710
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: