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Individual

JARRAD MICHAEL THACKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CDCA.173952

Contact information

Practice address
4968 GLENWAY AVE, CINCINNATI, OH 45238-3902
(513) 853-6575
Mailing address
1494 BEACON ST APT 3, CINCINNATI, OH 45230-2857
(513) 314-0708

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.173952
OH

Other

Enumeration date
01/12/2021
Last updated
01/12/2021
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