Organization
HISPANIC UMADAOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VICTOR OWEN PHILLIPS CDCA (COUNSELOR/CASE MANAGER)
(216) 351-3833
Entity
Organization
Contact information
Practice address
2202 PRAME AVE, CLEVELAND, OH 44109
(440) 876-7806
Mailing address
384 PROSPECT ST., BEREA, OH 44017
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
120988
OH
324500000X
Substance Abuse Rehabilitation Facility
120988
OH
Other
Enumeration date
06/15/2016
Last updated
12/28/2017
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