Healthcare Provider Details

I. General information

NPI: 1093606170
Provider Name (Legal Business Name): NICHOLE EMIRY CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7058 CORPORATE WAY STE 1
DAYTON OH
45459-4243
US

IV. Provider business mailing address

648 MAPLE HILL DR
DAYTON OH
45449-1728
US

V. Phone/Fax

Practice location:
  • Phone: 937-991-0083
  • Fax:
Mailing address:
  • Phone: 989-492-8939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.193109
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: