Provider Demographics
NPI:1568964906
Name:PERKINS, SIDNEY TYRONE (CDCA)
Entity Type:Individual
Prefix:MR
First Name:SIDNEY
Middle Name:TYRONE
Last Name:PERKINS
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 1:16321 LORAIN AVE APT 504
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5548
Mailing Address - Country:US
Mailing Address - Phone:216-391-0977
Mailing Address - Fax:216-391-0978
Practice Address - Street 1:3030 EUCLID AVE STE 312
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2518
Practice Address - Country:US
Practice Address - Phone:216-391-0977
Practice Address - Fax:216-391-0978
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH165712101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)