Individual
GERALD LEE BACCUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2400 W STROOP RD, DAYTON, OH 45439-2041
(614) 634-0195
Mailing address
PO BOX 10232, DAYTON, OH 45402-7232
(937) 559-2255
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
183243
OH
175T00000X
Peer Specialist
—
OH
Other
Enumeration date
01/24/2023
Last updated
09/15/2025
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