Sam R Ford, CDCA 11

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CDCA162201 Issued in OH

Practice address

500 Madison Ave Ste 340
Toledo, OH 43604-1277

Phone

(419) 360-8251

NPI assigned

Apr 21, 2023

Last updated

Apr 21, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1682035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682035200000",
    "number": "1710674486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2428 W CENTRAL AVE APT 2B",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063715",
            "telephone_number": "419-360-8251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 MADISON AVE STE 340",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041277",
            "telephone_number": "419-360-8251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORD",
        "first_name": "SAM",
        "middle_name": "R",
        "credential": "CDCA 11",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-04-21",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA162201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Malikah Ford, PHLEBOTOMIST
• Maliyah C Ford
• Pamela Ford
• Rebecca Ann Ford, P.T.
• Roxanne Ford
• Terrell Ford, QMHS
• Anita Foreman, MOL
• Erin Taylor Foreman, CT
• Ethel Foreman
• Timothy Quinn Foreman, LSW

• Addiction (Substance Use Disorder) Counselor in Toledo, OH
• Providers in Toledo, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.