Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LICDC.965593 | OH |
NPI | 1003571985 |
---|---|
Provider Name | Thomas Jerome Bach |
First Address | Cincinnati, OH 45247-6032 |
Second Address | Cincinnati, OH 45202-1413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2021 |
Last Update Date | 04/11/2021 |