Individual
JEFFERY STOUDERMIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
4977 NORTHCUTT PL, DAYTON, OH 45414-3839
(937) 387-6395
Mailing address
4977 NORTHCUTT PL, DAYTON, OH 45414-3839
(937) 387-6395
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.171501
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.177431
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0383979
—
OH
Enumeration date
12/12/2019
Last updated
07/07/2021
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