Individual
DUSTIN H SHORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
14574 US RT 23, WAVERLY, OH 45690
(740) 912-9126
Mailing address
14574 US RT 23, WAVERLY, OH 45690
(740) 703-9095
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.165070
OH
Other
Enumeration date
10/26/2017
Last updated
10/26/2017
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