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DERRELL ANTHONY FUQUA SR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CDCA

Contact information

Practice address
2529 BRIDGEPORT DR, DAYTON, OH 45406-1433
(937) 278-0869
Mailing address
2529 BRIDGEPORT DR, DAYTON, OH 45406-1433
(937) 278-0869

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
169214
OH

Other

Enumeration date
01/16/2019
Last updated
01/16/2019
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