Individual
MRS. HAZEL JOSA MAE LYONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CDCA
Contact information
Practice address
22664 STATE ROUTE 73, WEST PORTSMOUTH, OH 45663-6365
(740) 858-6690
(740) 858-6693
Mailing address
22664 STATE ROUTE 73, WEST PORTSMOUTH, OH 45663-6365
(740) 858-6690
(740) 858-6693
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
166897
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548782816
—
OH
Enumeration date
08/07/2018
Last updated
08/07/2018
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