Healthcare Provider Details

I. General information

NPI: 1043956782
Provider Name (Legal Business Name): ANDRIANNA CROSS CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 COSHOCTON AVE
MOUNT VERNON OH
43050-1900
US

IV. Provider business mailing address

509 N SANDUSKY ST
MOUNT VERNON OH
43050-2031
US

V. Phone/Fax

Practice location:
  • Phone: 866-534-2639
  • Fax:
Mailing address:
  • Phone: 740-485-3889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.188364
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: