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Organization
LICKING COUNTY ALCOHOLISM PREVENTION PROGRAM
Active
Organization
LICKING COUNTY ALCOHOLISM PREVENTION PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN JORDAN (EXECUTIVE DIRECTOR)
(740) 403-9494
Entity
Organization
Contact information
Practice address
62 E STEVENS ST, NEWARK, OH 43055-5969
(740) 366-7303
(740) 366-7305
Mailing address
62 E STEVENS ST, NEWARK, OH 43055-5969
(740) 366-7303
(740) 366-7305
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
01322
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01322
ODADAS
OH
05
—
45-579-01
—
OH
Enumeration date
03/29/2006
Last updated
02/21/2024
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