Provider Demographics
NPI:1134007594
Name:MEDINA, MICAH (CDCA)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:MEDINA
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:ELIZABETH
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:348 THRALL ST # 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-1614
Mailing Address - Country:US
Mailing Address - Phone:513-415-0525
Mailing Address - Fax:
Practice Address - Street 1:5122 GLENCROSSING WAY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3361
Practice Address - Country:US
Practice Address - Phone:513-827-9044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.192777101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)