Basic Information
| Provider Information | |||||||||
| NPI: | 1457859373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRAKE | ||||||||
| FirstName: | VERONICA | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | CDCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7460 BRANDT PIKE | ||||||||
| Address2: | |||||||||
| City: | HUBER HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454243240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373299370 | ||||||||
| FaxNumber: | 9372333516 | ||||||||
| Practice Location | |||||||||
| Address1: | 7460 BRANDT PIKE | ||||||||
| Address2: | |||||||||
| City: | HUBER HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454243240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373299370 | ||||||||
| FaxNumber: | 9372333516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2018 | ||||||||
| LastUpdateDate: | 01/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | CDCA.164073 | OH | N | Other Service Providers | Case Manager/Care Coordinator | 101YA0400X | CDCA.164073 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.