Provider Demographics
NPI:1548783426
Name:PRIDE, ALBERT JR (LICDC)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:PRIDE
Suffix:JR
Gender:M
Credentials:LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 E BUCHTEL AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-2338
Mailing Address - Country:US
Mailing Address - Phone:330-535-8116
Mailing Address - Fax:330-996-2233
Practice Address - Street 1:1804 EAST 55TH STREET
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103
Practice Address - Country:US
Practice Address - Phone:216-417-4213
Practice Address - Fax:216-938-8965
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161507101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000000Medicaid