Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | S0032203 | OH |
NPI | 1003173766 |
---|---|
Provider Name | Kelly A Garza |
First Address | Toledo, OH 43620-1703 |
Second Address | Toledo, OH 43620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2012 |
Last Update Date | 20/09/2018 |