Individual
MR. DESTRY P. FALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISW-S
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
I.0005409-SUPV
OH
1041C0700X
Clinical Social Worker
I.0005409-SUPV
OH
Other
Enumeration date
06/23/2010
Last updated
06/30/2010
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