Individual
BRETT RYAN CLEVIDENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
1341 MARKET AVE N, CANTON, OH 44714-2605
(330) 453-8252
(330) 452-4655
Mailing address
625 CLEVELAND AVE NW, CANTON, OH 44702-1805
(330) 455-0374
(330) 453-6716
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA174529
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0423863
—
OH
Enumeration date
11/12/2020
Last updated
12/22/2021
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