Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 923161 | OH |
N | 104100000X | Social Worker | S.0016323 | OH |
NPI | 1003178872 |
---|---|
Provider Name | David J. Kosko |
First Address | Parkersburg, WV 26102-1385 |
Second Address | Marietta, OH 45750-2363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2012 |
Last Update Date | 08/06/2012 |