Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 050185 | OH |
NPI | 1013044403 |
---|---|
Provider Name | Heather Gary |
First Address | Athens, OH 45701-2301 |
Second Address | Athens, OH 45701-2301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 24/07/2008 |