Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CDCA.164161 | OH |
NPI | 1003335548 |
---|---|
Provider Name | Patricia Ann Homza |
First Address | Elyria, OH 44035-6305 |
Second Address | Elyria, OH 44035-6305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2017 |
Last Update Date | 22/12/2021 |