Provider Demographics
NPI:1508361981
Name:OWENS, NICK WAYNE (CDCA)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:WAYNE
Last Name:OWENS
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11803 PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-4033
Mailing Address - Country:US
Mailing Address - Phone:216-406-2280
Mailing Address - Fax:216-404-1901
Practice Address - Street 1:22639 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-1622
Practice Address - Country:US
Practice Address - Phone:216-404-1900
Practice Address - Fax:216-404-1901
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH131506101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)