Healthcare Provider Details

I. General information

NPI: 1669380028
Provider Name (Legal Business Name): TRISSA MEADOWS CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 S 3RD ST
IRONTON OH
45638-2269
US

IV. Provider business mailing address

1724 S 3RD ST
IRONTON OH
45638-2269
US

V. Phone/Fax

Practice location:
  • Phone: 740-442-7143
  • Fax: 740-442-7145
Mailing address:
  • Phone: 740-442-7143
  • Fax: 740-442-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCAPRE.196763
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: