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Individual

ANTHONYESHA FAGAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
821 SOUTHBRIAR RD, TOLEDO, OH 43607-2561
(419) 279-3433
Mailing address
821 SOUTHBRIAR RD, TOLEDO, OH 43607-2561
(419) 705-9168

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
101YM0800X
Mental Health Counselor
Primary
171M00000X
Case Manager/Care Coordinator
171W00000X
Contractor
4807696
OH

Other

Enumeration date
02/20/2014
Last updated
06/03/2025
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