Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 081196-3 | OH |
NPI | 1003277765 |
---|---|
Provider Name | Sabrina Jones |
First Address | Lorain, OH 44053 |
Second Address | Lorain, OH 44053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2016 |
Last Update Date | 04/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LICDC.161639 | LICENSE (01) | OH |