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Individual
KELLY EADES
Active
Individual
KELLY EADES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDCA
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LCDCII.162034
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.181467
OH
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
08/18/2022
Last updated
08/21/2024
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