Healthcare Provider Details

I. General information

NPI: 1124671748
Provider Name (Legal Business Name): TAMIKA LYNN DOAKES CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ELMWOOD PARK DR
DAYTON OH
45449-5402
US

IV. Provider business mailing address

100 ELMWOOD PARK DR
DAYTON OH
45449-5402
US

V. Phone/Fax

Practice location:
  • Phone: 937-384-0580
  • Fax: 937-384-0581
Mailing address:
  • Phone: 937-384-0580
  • Fax: 937-384-0581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.180761
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-86166
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: