Provider Demographics
NPI:1366092140
Name:CRIDER, DE'SHA M (QMHS)
Entity type:Individual
Prefix:
First Name:DE'SHA
Middle Name:M
Last Name:CRIDER
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27645 BISHOP PARK DR APT 105
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44092-3065
Mailing Address - Country:US
Mailing Address - Phone:216-482-7298
Mailing Address - Fax:
Practice Address - Street 1:15700 LOTUS DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2427
Practice Address - Country:US
Practice Address - Phone:216-586-3887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2411003104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker