Provider Demographics
NPI:1669916789
Name:CADLE, LACRETIA
Entity type:Individual
Prefix:
First Name:LACRETIA
Middle Name:
Last Name:CADLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LACRETIA
Other - Middle Name:
Other - Last Name:MILNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANCONA
Mailing Address - Street 1:700 WESSEL DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014
Mailing Address - Country:US
Mailing Address - Phone:513-410-5008
Mailing Address - Fax:
Practice Address - Street 1:1251 NILES RD
Practice Address - Street 2:SUITE 5
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014
Practice Address - Country:US
Practice Address - Phone:888-830-0347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2025-08-29
Deactivation Date:2025-08-11
Deactivation Code:
Reactivation Date:2025-08-27
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3119351Medicaid