Provider Demographics
NPI:1134900871
Name:MCCREARY, FAITH LARAE (CDCA)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:LARAE
Last Name:MCCREARY
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:LARAE
Other - Last Name:MCCREARY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:633 EVESHAM AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-3803
Mailing Address - Country:US
Mailing Address - Phone:419-205-7613
Mailing Address - Fax:
Practice Address - Street 1:7140 PORT SYLVANIA DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1176
Practice Address - Country:US
Practice Address - Phone:567-408-7230
Practice Address - Fax:567-455-6299
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA183934101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)