Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CDCA.165935 | OH |
NPI | 1003306770 |
---|---|
Provider Name | Elizabeth A Dean |
First Address | Mansfield, OH 44906-3706 |
Second Address | Mansfield, OH 44906-3706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2018 |
Last Update Date | 17/05/2018 |