Individual
DYLAN LIJANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PRS
Contact information
Practice address
1320 WASHINGTON AVE, CLEVELAND, OH 44113-2333
(216) 781-0550
Mailing address
1320 WASHINGTON AVE, CLEVELAND, OH 44113-2333
(216) 781-0550
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000
CMS-HS
—
01
—
00568
PRS
OH
Enumeration date
05/21/2018
Last updated
05/21/2018
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