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General NPI Number Information
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NPI Number | 1073571360
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Entity Type | Organization
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Legal Business Name | DUAL DIAGNOSIS CENTER OF GREATER CLEVELAND INC
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2012 W 25TH ST STE 411
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City | CLEVELAND
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State | OH
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Zip | 44113-4131
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Country | US
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Telephone | 216-623-3555
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Fax | 216-623-3555
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Provider Business Mailing Address
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Address Line | 4486 SILSBY RD
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City | CLEVELAND
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State | OH
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Zip | 44118-3939
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Country | US
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Telephone | 216-623-3555
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Fax | 216-623-3555
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Authorized Official
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Title or Position | PRESIDENT
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Name | BARBARA O BERES
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Credential | LICDC, LPC
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Telephone | 216-623-3555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 12259, 575
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License Number State | OH
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