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Addiction Substance Use Disorder

Cincinnati, Ohio

Provider NPI: 1306841689

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
Tel: 513-260-1778  Fax: 513-961-8646

Business Mailing Address:
Tel: 513-260-1778  Fax: 513-961-8646

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
X101YA0400XBehavioral Health & Social Service Providers
Addiction (Substance Use Disorder)
X101YM0800XBehavioral Health & Social Service Providers
X103T00000XBehavioral Health & Social Service Providers
X1041C0700XBehavioral Health & Social Service Providers
Social Worker
X1041C0700XBehavioral Health & Social Service Providers
Social Worker

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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