Individual
JEREMY BRUCE EDMONSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
4977 NORTHCUTT PL, DAYTON, OH 45414-3839
(937) 387-6395
Mailing address
4977 NORTHCUTT PL, DAYTON, OH 45414-3839
(937) 687-6395
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
174194
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
177351
OH
Other
Enumeration date
11/11/2020
Last updated
02/15/2022
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