Individual
DUSTIN SHEPHERD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14574 US HIGHWAY 23, WAVERLY, OH 45690-9373
(740) 912-9126
Mailing address
5507 BEAVER PIKE, BEAVER, OH 45613-9701
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
141595
OH
Other
Enumeration date
02/16/2018
Last updated
02/16/2018
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