Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003495672 |
---|---|
Provider Name | Adam Parker |
First Address | Dayton, OH 45459-3643 |
Second Address | Dayton, OH 45417-3445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2021 |
Last Update Date | 02/04/2021 |