Individual
DARRYLE SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
3103 DIXIE HWY, HAMILTON, OH 45015-1653
(513) 892-4673
(513) 737-1107
Mailing address
100 CROWNE POINT PL, CINCINNATI, OH 45241-5427
(513) 743-7628
(513) 737-1107
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.020492
OH
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0278996
—
OH
Enumeration date
10/20/2017
Last updated
01/29/2024
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