Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 140757 | OH |
NPI | 1003426917 |
---|---|
Provider Name | Caresse Boyd |
First Address | Dayton, OH 45422-3000 |
Second Address | Dayton, OH 45422-3000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2020 |
Last Update Date | 12/08/2020 |