Provider Demographics
NPI:1881307171
Name:COX, AMY LOUISE (CDCA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:COX
Suffix:
Gender:
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1805
Mailing Address - Country:US
Mailing Address - Phone:330-455-0374
Mailing Address - Fax:330-453-6716
Practice Address - Street 1:1680 NAVE RD SE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-9604
Practice Address - Country:US
Practice Address - Phone:330-830-8740
Practice Address - Fax:330-830-0912
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.190681101YA0400X
247200000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other