Provider Demographics
NPI:1194581850
Name:CARDER, KENNETH R (CPRS-HIGH SCHOOL)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:R
Last Name:CARDER
Suffix:
Gender:M
Credentials:CPRS-HIGH SCHOOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1666
Mailing Address - Country:US
Mailing Address - Phone:330-962-5495
Mailing Address - Fax:
Practice Address - Street 1:1034 BROWN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44301-1515
Practice Address - Country:US
Practice Address - Phone:330-388-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.004288101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty