Individual
ANTHONY IMAGIE-DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICDC
Contact information
Practice address
1875 STONERIDGE DR, CIRCLEVILLE, OH 43113-8956
(740) 500-1391
Mailing address
2065 STONERIDGE DR, CIRCLEVILLE, OH 43113-8956
(740) 500-1391
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LICDC.111022
OH
Other
Enumeration date
05/05/2021
Last updated
05/05/2021
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