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Individual

BROCK WOLFORD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CDCA

Contact information

Practice address
30663 RED ROCK CT # 1, LOGAN, OH 43138-9672
(740) 888-1377
Mailing address
30663 RED ROCK CT # 1, LOGAN, OH 43138-9672
(740) 888-1377

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
169242
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0096642
OH
Enumeration date
02/07/2019
Last updated
02/07/2019
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