Healthcare Provider Details

I. General information

NPI: 1427455120
Provider Name (Legal Business Name): ORION MONROE LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10534 SUCCESS LN MEN'S MENTAL HEALTH INITIATIVE, SUITE E
DAYTON OH
45458-3655
US

IV. Provider business mailing address

10534 SUCCESS LN MEN'S MENTAL HEALTH INITIATIVE, SUITE E
DAYTON OH
45458-3655
US

V. Phone/Fax

Practice location:
  • Phone: 937-532-6244
  • Fax: 937-919-5509
Mailing address:
  • Phone: 937-532-6244
  • Fax: 937-919-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number160697
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE 1300796
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: