Provider Demographics
NPI:1720575616
Name:CAMBRIDGE, NADINE ALICIA (LCDC II)
Entity Type:Individual
Prefix:MS
First Name:NADINE
Middle Name:ALICIA
Last Name:CAMBRIDGE
Suffix:
Gender:F
Credentials:LCDC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 DAYTON TOWERS DR APT 12G
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-1136
Mailing Address - Country:US
Mailing Address - Phone:740-591-1213
Mailing Address - Fax:
Practice Address - Street 1:777 COLUMBUS AVE STE 7-D
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1684
Practice Address - Country:US
Practice Address - Phone:513-228-6590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCII.161311101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)