Healthcare Provider Details

I. General information

NPI: 1871020388
Provider Name (Legal Business Name): KELLEY KAYE ROSS-HOPKINS LCDCIII
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 W MARKET ST
FAIRLAWN OH
44333-4540
US

IV. Provider business mailing address

1182 MOUNT VERNON AVE
AKRON OH
44310-1104
US

V. Phone/Fax

Practice location:
  • Phone: 330-436-0956
  • Fax:
Mailing address:
  • Phone: 330-256-8847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.121033
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.005267
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: