Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003584103 |
---|---|
Provider Name | Geoffrey Scott Lewis |
First Address | Jackson, OH 45640-1226 |
Second Address | Jackson, OH 45640-1226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2021 |
Last Update Date | 02/09/2021 |