Provider Demographics
NPI:1548027469
Name:ADDISON, ARRICK JR
Entity type:Individual
Prefix:
First Name:ARRICK
Middle Name:
Last Name:ADDISON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3236 PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-3834
Mailing Address - Country:US
Mailing Address - Phone:216-543-8135
Mailing Address - Fax:
Practice Address - Street 1:23660 MILES RD STE 100
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5461
Practice Address - Country:US
Practice Address - Phone:419-392-5969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician