Individual
JACI R GUMP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8402 BLACKJACK RD, MOUNT VERNON, OH 43050-9193
(740) 485-9887
Mailing address
8402 BLACKJACK RD, MOUNT VERNON, OH 43050-9193
(740) 485-9887
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.173829
OH
171M00000X
Case Manager/Care Coordinator
1811469638
OH
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
12/18/2018
Last updated
03/17/2025
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