Individual
ANDREA DISMUKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6400 E BROAD ST. FL4, COLUMBUS, OH 43213-1505
(614) 655-3345
Mailing address
6400 E BROAD ST FL 4, COLUMBUS, OH 43213-1505
(614) 655-3345
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
05/11/2018
Last updated
09/25/2019
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