Individual
MR. ANTHONY MICHAEL MOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CDCA,QMHS
Contact information
Practice address
14574 US HIGHWAY 23, WAVERLY, OH 45690-9373
(740) 912-9126
Mailing address
PO BOX 226, WAVERLY, OH 45690-0226
(740) 947-6727
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101YA0400X
—
OH
Enumeration date
11/15/2017
Last updated
11/15/2017
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