Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 161374 | OH |
N | 101YM0800X | Mental Health Counselor | QMHS | OH |
NPI | 1003326653 |
---|---|
Provider Name | Randy Wayne Cable II |
First Address | Ironton, OH 45638-1403 |
Second Address | Ironton, OH 45638-1403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2017 |
Last Update Date | 19/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
161374 | (05) | OH |