Individual
JACOB B GILMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCDC III
Contact information
Practice address
4930 ENTERPRISE DR NW, WARREN, OH 44481-8706
(330) 787-0955
Mailing address
4930 ENTERPRISE DR NW, WARREN, OH 44481-8706
(330) 787-0955
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDCIII162380
OH
324500000X
Substance Abuse Rehabilitation Facility
170920
OH
Other
Enumeration date
07/09/2019
Last updated
03/07/2025
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