Provider Demographics
NPI:1790201804
Name:RADFORD, ALEXIS (LCDCII)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:
Last Name:RADFORD
Suffix:
Gender:F
Credentials:LCDCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 31ST ST SW
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-7859
Mailing Address - Country:US
Mailing Address - Phone:330-608-1715
Mailing Address - Fax:
Practice Address - Street 1:941 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-2467
Practice Address - Country:US
Practice Address - Phone:330-374-9610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141203101YA0400X
OHLCDCII.141203101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty