Organization
B. RILEY SOBER HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH ALEXANDER M.ED., LPCC, LICDC (CLINICAL SUPERVISOR)
(216) 444-1195
Entity
Organization
Contact information
Practice address
3719 DENISON AVE, CLEVELAND, OH 44109-2691
(216) 417-4831
Mailing address
3719 DENISON AVE, CLEVELAND, OH 44109-2691
(216) 417-4831
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154835007
—
OH
Enumeration date
01/16/2019
Last updated
01/16/2019
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