Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CDCA.176561 | OH |
N | 101YP1600X | Pastoral Counselor |
NPI | 1033748629 |
---|---|
Provider Name | Mr. Joshua Lee Melvin |
First Address | Cincinnati, OH 45202-1457 |
Second Address | Marion, OH 43302-2331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2020 |
Last Update Date | 23/07/2021 |