Individual
ALEXIS DEATHERAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDCA
Contact information
Practice address
1100 HOSPITAL DR, BATAVIA, OH 45103-1920
(513) 834-7063
(513) 873-1567
Mailing address
446 MORGAN ST, CINCINNATI, OH 45206-2348
(513) 834-7063
(513) 873-1567
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.170445
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0347809
—
OH
Enumeration date
05/01/2018
Last updated
05/15/2019
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