Organization
DECLARE THERAPY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PURCELL TAYLOR JR. ED.D. (PRESIDENT CEO)
(513) 290-7908
Entity
Organization
Contact information
Practice address
700 W PETE ROSE WAY, CINCINNATI, OH 45203-1892
(513) 290-7908
(513) 834-7052
Mailing address
700 W PETE ROSE WAY STE 456, CINCINNATI, OH 45203-1875
(513) 834-7050
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
85387
OH
251S00000X
Community/Behavioral Health Agency
Primary
E0000656, 85387
OH
Other
Enumeration date
02/24/2009
Last updated
01/19/2012
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