Healthcare Provider Details

I. General information

NPI: 1467120915
Provider Name (Legal Business Name): JESSICA DIANE MEYER CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/26/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 CENTERVILLE BUSINESS PKWY STE 310
CENTERVILLE OH
45459-2697
US

IV. Provider business mailing address

1681 E DOROTHY LN APT 22
KETTERING OH
45429-3835
US

V. Phone/Fax

Practice location:
  • Phone: 937-637-6735
  • Fax:
Mailing address:
  • Phone: 937-499-0069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number176041
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: