Individual provider Active NPI

Diedre Rose Fleming, MS, MSW, LICDC, LSW

  • Addiction (Substance Use Disorder) Counselor
  • Ashtabula, OH
National Provider Identifier
1578050720
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
LCDCIII.161336 Issued in OH
Practice address
2801 C CT
Ashtabula, OH 44004-4577
Phone
(440) 998-4210
NPI assigned
Apr 13, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X S.2005340 OH
Addiction (Substance Use Disorder) Counselor 101YA0400X LICDC.162024 OH
Addiction (Substance Use Disorder) Counselor 101YA0400X LCDCIII.161336 OH Primary

Addresses

Primary practice location

2801 C CT
Ashtabula, OH 44004-4577

Mailing address

2801 C CT
Ashtabula, OH 44004-4577
Phone (440) 998-0722

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230120000282 OH Practitioner - Clinical Social Worker 9739550245 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ravenwood Mental Health CenterGroup PAC ID 6901813922, 57 clinicians

Practice addresses (Care Compare)

12557 Ravenwood Dr
Chardon, OH 44024-9009
Phone (440) 285-3568

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
LCDCIII.161336OHMDAddiction (Substance Use Disorder) Counselor
LICDC.162024OHMDAddiction (Substance Use Disorder) Counselor
S.2005340OHMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Ravenwood Mental Health Center Addiction (Substance Use Disorder) CurrentSince Feb 2, 2026 Accepting new patients
Community Counseling Center of Ashtabula County CurrentSince Jan 2, 2024 Accepting new patients
Ravenwood Mental Health Center CurrentSince Feb 2, 2026 Accepting new patients
Crossroads Health Past Accepting new patients

Locations

2801 C Ct
Ashtabula, OH 44004
Phone (440) 998-0722

12557 Ravenwood Dr
Concord Twp, OH 44024
Phone (440) 990-6104

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/ravenwoodhealth/r4/

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1578050720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 C CT",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440044577",
            "telephone_number": "440-998-0722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 C CT",
            "city": "ASHTABULA",
            "state": "OH",
            "postal_code": "440044577",
            "telephone_number": "440-998-4210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLEMING",
        "first_name": "DIEDRE",
        "middle_name": "ROSE",
        "name_prefix": "Ms.",
        "credential": "MS, MSW, LICDC, LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-13",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "S.2005340",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LICDC.162024",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LCDCIII.161336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ashtabula, OH

Sources for this page

Verify at the official NPI Registry.