Provider Demographics
NPI:1023889649
Name:GAMBLE, MICHAEL (PHD, AMP, CDCA)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:GAMBLE
Suffix:
Gender:M
Credentials:PHD, AMP, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 S MAIN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-4401
Mailing Address - Country:US
Mailing Address - Phone:330-474-9601
Mailing Address - Fax:
Practice Address - Street 1:526 S MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-4401
Practice Address - Country:US
Practice Address - Phone:330-474-9601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.192166101YA0400X
251S00000X, 171400000X, 174H00000X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No174H00000XOther Service ProvidersHealth Educator