Individual
JAMES SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
897 E IRON AVE, DOVER, OH 44622-2030
(330) 343-5555
(330) 343-1601
Mailing address
897 E IRON AVE, DOVER, OH 44622-2030
(330) 343-5555
(330) 343-1601
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.161142
OH
Other
Enumeration date
10/05/2016
Last updated
10/05/2016
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