Healthcare Provider Details

I. General information

NPI: 1316465503
Provider Name (Legal Business Name): ARTUR SHAWN FAISON CDCA, NCAC I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 09/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22639 EUCLID AVE
EUCLID OH
44117-1622
US

IV. Provider business mailing address

26245 PETTIBONE RD
OAKWOOD VILLAGE OH
44146-6452
US

V. Phone/Fax

Practice location:
  • Phone: 216-404-1900
  • Fax: 216-404-1901
Mailing address:
  • Phone: 216-210-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number016868
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number011401
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: