Healthcare Provider Details

I. General information

NPI: 1669195186
Provider Name (Legal Business Name): CHRISTINA TRIPLETT CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9083 MENTOR AVE
MENTOR OH
44060-6462
US

IV. Provider business mailing address

9083 MENTOR AVE
MENTOR OH
44060-6462
US

V. Phone/Fax

Practice location:
  • Phone: 440-255-0678
  • Fax: 440-255-6348
Mailing address:
  • Phone: 440-255-0678
  • Fax: 440-255-6348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.192091
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: