Healthcare Provider Details

I. General information

NPI: 1669916789
Provider Name (Legal Business Name): LACRETIA CADLE CT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LACRETIA MILNER ANCONA

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date: 08/11/2025
Reactivation Date: 08/27/2025

III. Provider practice location address

1251 NILES RD SUITE 5
FAIRFIELD OH
45014
US

IV. Provider business mailing address

700 WESSEL DR
FAIRFIELD OH
45014-3612
US

V. Phone/Fax

Practice location:
  • Phone: 888-830-0347
  • Fax:
Mailing address:
  • Phone: 513-410-5008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2507184-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: