Provider Demographics
NPI:1679049233
Name:POWELL, TIESHA G (CDCA)
Entity Type:Individual
Prefix:
First Name:TIESHA
Middle Name:G
Last Name:POWELL
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 1:1 N COMMERCE PARK DR # 318
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-3187
Mailing Address - Country:US
Mailing Address - Phone:513-761-0158
Mailing Address - Fax:
Practice Address - Street 1:1 N COMMERCE PARK DR # 318
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-3187
Practice Address - Country:US
Practice Address - Phone:513-761-0158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.172483101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)