Provider Demographics
NPI:1558969642
Name:DEARING, CODY R (BA, CDCA)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:R
Last Name:DEARING
Suffix:
Gender:M
Credentials:BA, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5463 MCGREGOR LN
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2418
Mailing Address - Country:US
Mailing Address - Phone:419-262-5297
Mailing Address - Fax:
Practice Address - Street 1:6202 TRUST DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8425
Practice Address - Country:US
Practice Address - Phone:419-824-8462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.172916101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)