Provider Demographics
NPI:1386155083
Name:MCCALE, MATTHEW LUKE (CDCA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:LUKE
Last Name:MCCALE
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:MR
Other - First Name:MATTHEW
Other - Middle Name:LUKE
Other - Last Name:MCCALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDCA 163474
Mailing Address - Street 1:2151 RUSH BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44507-1535
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2151 RUSH BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44507-1535
Practice Address - Country:US
Practice Address - Phone:330-744-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.163474101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)