Healthcare Provider Details

I. General information

NPI: 1578354890
Provider Name (Legal Business Name): COSHOCTON COUNTY DRUG & ALCOHOL COUNCIL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 WALNUT ST
COSHOCTON OH
43812-1655
US

IV. Provider business mailing address

610 WALNUT ST
COSHOCTON OH
43812-1655
US

V. Phone/Fax

Practice location:
  • Phone: 740-622-0033
  • Fax:
Mailing address:
  • Phone: 740-622-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JEANETTE SUE HALL
Title or Position: CO EXECUTIVE DIRECTOR
Credential: LPCC-S, LICDC-CS
Phone: 740-622-0033