Individual
JAMES LLOYD BACK SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
2775 STATE ROUTE 39, SHELBY, OH 44875-9466
(419) 565-5955
Mailing address
2775 STATE ROUTE 39, SHELBY, OH 44875-9466
(419) 747-3322
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.981099
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
76-0545741
—
OH
Enumeration date
04/04/2018
Last updated
04/11/2018
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