Provider Demographics
NPI:1275113979
Name:DRAKE, TEGAN JEAN (CDCA, RA)
Entity Type:Individual
Prefix:MS
First Name:TEGAN
Middle Name:JEAN
Last Name:DRAKE
Suffix:
Gender:F
Credentials:CDCA, RA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 WHEELING AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-2340
Mailing Address - Country:US
Mailing Address - Phone:740-439-4532
Mailing Address - Fax:740-439-1031
Practice Address - Street 1:927 WHEELING AVE STE 310
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2340
Practice Address - Country:US
Practice Address - Phone:740-439-4532
Practice Address - Fax:740-439-1031
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH173518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)