Individual
DUSTIN KUBACKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CDCA
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
165529
OH
324500000X
Substance Abuse Rehabilitation Facility
Primary
168900
OH
Other
Enumeration date
02/21/2018
Last updated
06/17/2019
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