Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 841092 | OH |
N | 104100000X | Social Worker | S,0016334 | OH |
NPI | 1003038258 |
---|---|
Provider Name | Mr. Kenneth Lloyd JR. |
First Address | Warren, OH 44481-1222 |
Second Address | Warren, OH 44481-1222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |