MEDICARE: ANDRIANNA CROSS CDCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.188364	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043956782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRIANNA CROSS CDCA

Provider Business Mailing Address
First Line	:	509 N SANDUSKY ST
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-2031
Country	:	US
Telephone Number	:	740-485-3889
Fax Number	:

Provider Business Practice Location Address
First Line	:	809 COSHOCTON AVE
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1900
Country	:	US
Telephone Number	:	866-534-2639
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2022
Last Update Date	:	01/06/2026

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Directions to “ ANDRIANNA CROSS CDCA” Practice Location

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