Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003329749 |
---|---|
Provider Name | David William Laverick JR. |
First Address | Waverly, OH 45690-9373 |
Second Address | Waverly, OH 45690-9373 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2017 |
Last Update Date | 15/11/2017 |