Individual
DAVID FATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
2115 W PARK DR, LORAIN, OH 44053-1138
(440) 989-4900
(440) 282-4779
Mailing address
2115 W PARK DR, LORAIN, OH 44053-1138
(440) 989-4900
(440) 282-4779
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CDCA.164602
LICENSE
OH
Enumeration date
04/24/2018
Last updated
04/24/2018
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