Healthcare Provider Details

I. General information

NPI: 1285495564
Provider Name (Legal Business Name): TAKESHIA DOZIER CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/23/2024
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20611 EUCLID AVE
EUCLID OH
44117-1521
US

IV. Provider business mailing address

1379 YELLOWSTONE RD
CLEVELAND HEIGHTS OH
44121-1564
US

V. Phone/Fax

Practice location:
  • Phone: 205-729-3483
  • Fax:
Mailing address:
  • Phone: 205-729-3483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberCDCA.185514
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: