Provider Demographics
NPI:1891226163
Name:ROSS, DEBORAH (CDCA II)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:CDCA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1882 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-1812
Mailing Address - Country:US
Mailing Address - Phone:440-989-4968
Mailing Address - Fax:
Practice Address - Street 1:1882 E 32ND ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-1812
Practice Address - Country:US
Practice Address - Phone:440-989-4968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150282101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)