Individual
KENTON DURHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2960 W ENON RD, XENIA, OH 45385-8548
(937) 272-4925
(937) 984-4346
Mailing address
2960 W ENON RD, XENIA, OH 45385-8548
(937) 272-4925
(937) 984-4346
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
M.2400388-TRNE
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.182506
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.186062
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0002801
—
OH
Enumeration date
11/04/2022
Last updated
05/07/2024
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