Provider Demographics
NPI:1639662513
Name:JARRETT, KEVIN MICHELLE (CDCA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MICHELLE
Last Name:JARRETT
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 1:3301 ARCHMERE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-5400
Mailing Address - Country:US
Mailing Address - Phone:216-346-8608
Mailing Address - Fax:
Practice Address - Street 1:3301 ARCHMERE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-5400
Practice Address - Country:US
Practice Address - Phone:216-346-8608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH167299101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)