Healthcare Provider Details

I. General information

NPI: 1578263596
Provider Name (Legal Business Name): SHEILA CLARKSON CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 STELTON RD
XENIA OH
45385-5220
US

IV. Provider business mailing address

PO BOX 212
XENIA OH
45385-0212
US

V. Phone/Fax

Practice location:
  • Phone: 937-708-8348
  • Fax:
Mailing address:
  • Phone: 937-708-8348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.183248
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCDCA.183248
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: