Healthcare Provider Details

I. General information

NPI: 1386596542
Provider Name (Legal Business Name): JOSHUA PAUL WILKES CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21270 LORAIN RD
FAIRVIEW PARK OH
44126-2121
US

IV. Provider business mailing address

24752 EAGLE POINTE
COLUMBIA STATION OH
44028-8924
US

V. Phone/Fax

Practice location:
  • Phone: 440-672-1299
  • Fax:
Mailing address:
  • Phone: 440-896-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number261QR0405X
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: