Individual
CRYSTAL GAIL CISCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDCA
Contact information
Practice address
1505 N COLE ST, LIMA, OH 45801-2432
(833) 510-4357
Mailing address
4600 MONTGOMERY RD STE 400, CINCINNATI, OH 45212-2600
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000741747
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.194767
OH
175T00000X
Peer Specialist
004930
OH
Other
Enumeration date
08/08/2024
Last updated
03/09/2026
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