Healthcare Provider Details

I. General information

NPI: 1891468922
Provider Name (Legal Business Name): KAYLA MICHELLE SHEA CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 W PARK DR
LORAIN OH
44053-1138
US

IV. Provider business mailing address

1322 W ERIE AVE # C
LORAIN OH
44052-1320
US

V. Phone/Fax

Practice location:
  • Phone: 440-989-4900
  • Fax:
Mailing address:
  • Phone: 440-258-9059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number177657
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: