Individual
JAIMERIA NICOLE MCKOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3411 OFFICE PARK DR, DAYTON, OH 45439-2298
(937) 802-5440
Mailing address
3411 OFFICE PARK DR, DAYTON, OH 45439-2298
(937) 802-5440
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
189387
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009128
—
OH
05
—
0411413
—
OH
Enumeration date
07/29/2024
Last updated
07/29/2024
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