Individual
GARY DISALLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
1212 TOD PL NW, WARREN, OH 44485-2475
(330) 469-6822
(330) 294-5641
Mailing address
PO BOX 1212, WARREN, OH 44482-1212
(330) 469-6822
(330) 294-5641
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
165707
OH
Other
Enumeration date
07/26/2018
Last updated
07/25/2023
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