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NPI Code Detail

MEDICARE: TARA DAREE FOXWORTH CDCA

MEDICARE: TARA DAREE FOXWORTH 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
1101YA0400XAddiction (Substance Use Disorder) Counselor160112OH

General Provider Information

NPI Number : 1720439425
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA DAREE FOXWORTH CDCA
Provider Business Mailing Address
First Line : 1227 ANSEL RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44108-3323
Country : US
Telephone Number : 216-421-0662
Fax Number : 216-421-0911
Provider Business Practice Location Address
First Line : 1227 ANSEL RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44108-3323
Country : US
Telephone Number : 216-421-0662
Fax Number : 216-421-0911
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2016
Last Update Date : 06/24/2016

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Directions to “ TARA DAREE FOXWORTH CDCA” Practice Location

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