Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003429317 |
---|---|
Provider Name | Nikita Trimble |
First Address | Xenia, OH 45385-2815 |
Second Address | Xenia, OH 45385-2815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2020 |
Last Update Date | 26/08/2020 |