Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LCDCII.161603 | OH |
NPI | 1003320938 |
---|---|
Provider Name | Quanice Locke |
First Address | Cincinnati, OH 45202-1459 |
Second Address | Columbus, OH 43228-9671 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2017 |
Last Update Date | 17/08/2020 |