Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CDCA.110082 | OH |
NPI | 1003314113 |
---|---|
Provider Name | Larry Muhammad |
First Address | Cincinnati, OH 45202-1457 |
Second Address | Springfield, OH 45504-2650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2018 |
Last Update Date | 12/01/2022 |