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NPI 1679358030 · Addiction (Substance Use Disorder) Counselor · Jackson, OH
Provider details
- NPI number
- 1679358030
- Entity type
- Individual
- Primary specialty
- Addiction (Substance Use Disorder) CounselorBehavioral Health & Social Service Providers
- Sex
- Male
- Sole proprietor
- Yes
Specialties & taxonomies
Behavioral Health & Social Service Providers
- Mental Health Counselor101YM0800X
Behavioral Health & Social Service Providers
Practice location
502 Mccarty Ln Ste 1
Jackson, OH 45640-7025
Phone: (740) 577-9003
Approximate (ZIP-level) locationGet directions
Mailing address
502 Mccarty Ln Ste 1
Jackson, OH 45640-7025
Registry dates
- Enumerated
- 2023-08-25
- Last updated
- 2023-08-25
- Certified
- 2023-08-25
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.