Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 161965 | OH |
NPI | 1003390790 |
---|---|
Provider Name | Keith L Warren SR. |
First Address | Columbus, OH 43235-5983 |
Second Address | Columbus, OH 43235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2018 |
Last Update Date | 11/06/2019 |