Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 167101 | OH |
NPI | 1003332156 |
---|---|
Provider Name | Amanda Renee Baker |
First Address | Dayton, OH 45403-1850 |
Second Address | Dayton, OH 45403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2017 |
Last Update Date | 27/06/2018 |