Provider Demographics
NPI:1831625391
Name:CORRY, JOHN (CDCA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CORRY
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 OBERLIN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3173
Mailing Address - Country:US
Mailing Address - Phone:216-972-7261
Mailing Address - Fax:216-916-4783
Practice Address - Street 1:4520 OBERLIN AVE STE 2
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3173
Practice Address - Country:US
Practice Address - Phone:216-972-7261
Practice Address - Fax:216-916-4783
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA161819101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)