Individual
COURTNEY PHELPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CDCA. 173558
Contact information
Practice address
323 MARION PIKE STE 3, COAL GROVE, OH 45638-2958
(740) 646-6640
Mailing address
323 MARION PIKE STE 3, COAL GROVE, OH 45638-2958
(740) 646-6640
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.173558
OH
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0292316
—
OH
Enumeration date
04/23/2018
Last updated
05/07/2020
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