Healthcare Provider Details

I. General information

NPI: 1851126064
Provider Name (Legal Business Name): MICHELLE WEAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1088 WASSERMAN WAY
BATAVIA OH
45103
US

IV. Provider business mailing address

1501 MADISON RD
CINCINNATI OH
45206
US

V. Phone/Fax

Practice location:
  • Phone: 513-735-8100
  • Fax:
Mailing address:
  • Phone: 513-354-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.189614
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: