Healthcare Provider Details

I. General information

NPI: 1861176547
Provider Name (Legal Business Name): MERCEDES DUNLAP LCDCII.162286
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 MARION PIKE STE 1
COAL GROVE OH
45638-2958
US

IV. Provider business mailing address

323 MARION PIKE STE 1
COAL GROVE OH
45638-2958
US

V. Phone/Fax

Practice location:
  • Phone: 740-237-4981
  • Fax: 877-325-2816
Mailing address:
  • Phone: 740-237-4981
  • Fax: 877-325-2816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.185609
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCII.162286
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: