Healthcare Provider Details

I. General information

NPI: 1538435151
Provider Name (Legal Business Name): FRANKLIN D. WYLIE LICDC-CS, ICCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 FOLSOM DR
DAYTON OH
45405-1111
US

IV. Provider business mailing address

219 FOLSOM DR
DAYTON OH
45405-1111
US

V. Phone/Fax

Practice location:
  • Phone: 859-630-2045
  • Fax:
Mailing address:
  • Phone: 859-630-2045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.081254
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: