Healthcare Provider Details

I. General information

NPI: 1447870670
Provider Name (Legal Business Name): DJM RECOVERY SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 W 16TH ST
ASHTABULA OH
44004-3018
US

IV. Provider business mailing address

1809 W 16TH ST
ASHTABULA OH
44004-3018
US

V. Phone/Fax

Practice location:
  • Phone: 440-490-5234
  • Fax:
Mailing address:
  • Phone: 440-490-5234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: LOIS MILLER-MARTONE
Title or Position: OWNER
Credential: LICDC-CS
Phone: 440-490-5234