Healthcare Provider Details

I. General information

NPI: 1770402190
Provider Name (Legal Business Name): MICHAEL DEWAYNE FRAZIER CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

379 E BARTHMAN AVE
COLUMBUS OH
43207-1921
US

IV. Provider business mailing address

7432 BASIL WESTERN RD NW
CANAL WINCHESTER OH
43110-9207
US

V. Phone/Fax

Practice location:
  • Phone: 380-799-6061
  • Fax: 614-396-9300
Mailing address:
  • Phone: 380-799-6061
  • Fax: 614-396-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.PRE196333
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: