Individual
ALYSSA EMANI IDEIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDCA
Contact information
Practice address
99 N BRICE RD STE 320, COLUMBUS, OH 43213-6519
(614) 759-1176
Mailing address
3676 BRACKNELL FOREST DR, GROVEPORT, OH 43125-9160
(440) 382-5479
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.163937
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CDCA.163937
CHEMICAL DEPENDENCY PROFESSIONALS BOARD
OH
Enumeration date
12/23/2017
Last updated
03/17/2018
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