Individual
BRYAN ALDEN PENNINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDCA PHASE 1
Contact information
Practice address
1 ELIZABETH PL, DAYTON, OH 45417-3445
(937) 813-1737
Mailing address
1 ELIZABETH PL, DAYTON, OH 45417-3445
(937) 813-1737
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
168459
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCDCII.161727
OH
Other
Enumeration date
11/02/2018
Last updated
08/10/2021
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