Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | OH | |
N | 101YM0800X | Mental Health Counselor | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1184293052 |
---|---|
Provider Name | Ms. Tia Nicole Underwood |
First Address | Delaware, OH 43015-8316 |
Second Address | Delaware, OH 43015-8316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2021 |
Last Update Date | 23/06/2021 |