Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 131514 | OH |
NPI | 1003352766 |
---|---|
Provider Name | Billie Ray |
First Address | Portsmouth, OH 45662-4093 |
Second Address | Portsmouth, OH 45662-4093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2017 |
Last Update Date | 18/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101YA0400X | (05) | OH |