Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CDCA.166229 | OH |
NPI | 1003318734 |
---|---|
Provider Name | Sean Howard Grossarth |
First Address | Lancaster, OH 43130-4315 |
Second Address | Lancaster, OH 43130-4315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2018 |
Last Update Date | 08/03/2018 |