Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 140890 | OH |
NPI | 1003346875 |
---|---|
Provider Name | Lisa Doster |
First Address | Perrysville, OH 44864-9407 |
Second Address | Perrysville, OH 44864-9407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2017 |
Last Update Date | 14/06/2017 |