Provider Demographics
NPI:1144720160
Name:WEST, MICHELLE RENEE (CDCA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:WEST
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 SPRING GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45225-1821
Mailing Address - Country:US
Mailing Address - Phone:513-853-6930
Mailing Address - Fax:
Practice Address - Street 1:3129 SPRING GROVE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45225-1821
Practice Address - Country:US
Practice Address - Phone:513-853-6930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH164437101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCDA164437OtherOHIO CHEMICAL DEPENDENCY BOARD