Provider Demographics
NPI:1386109197
Name:CREGO, ALISHA ILENE (CDCA)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:ILENE
Last Name:CREGO
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:ILENE
Other - Last Name:CREGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDCA
Mailing Address - Street 1:360 S GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5537
Mailing Address - Country:US
Mailing Address - Phone:614-398-3470
Mailing Address - Fax:614-340-9083
Practice Address - Street 1:360 S GRANT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5537
Practice Address - Country:US
Practice Address - Phone:614-398-3470
Practice Address - Fax:614-340-9083
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH169560101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty