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NPI Code Detail

MEDICARE: CANDACE MONTGOMERY PEER SUPPORT/CDCA

MEDICARE: CANDACE MONTGOMERY PEER SUPPORT/CDCA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer SpecialistAPS006806OH
2101YA0400XAddiction (Substance Use Disorder) CounselorCDCA195013OH

General Provider Information

NPI Number : 1366316135
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDACE MONTGOMERY PEER SUPPORT/CDCA
Provider Business Mailing Address
First Line : 202 BURKHARDT AVE
Second Line :
City : DAYTON
State : OH
Zip : 45403-2774
Country : US
Telephone Number : 937-270-4846
Fax Number :
Provider Business Practice Location Address
First Line : 4977 NORTHCUTT PL
Second Line :
City : DAYTON
State : OH
Zip : 45414-3839
Country : US
Telephone Number : 800-829-5461
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2025
Last Update Date : 01/29/2026

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