Provider Demographics
NPI:1639800287
Name:PIXLEY, ROSE (CDCA)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:PIXLEY
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 WOODLAND ST NE UNIT A
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-5348
Mailing Address - Country:US
Mailing Address - Phone:330-469-6777
Mailing Address - Fax:330-469-6779
Practice Address - Street 1:1705 WOODLAND ST NE UNIT A
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-5348
Practice Address - Country:US
Practice Address - Phone:330-469-6777
Practice Address - Fax:330-469-6779
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.180909101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCDCA.180909OtherOMHAS