Healthcare Provider Details

I. General information

NPI: 1982295986
Provider Name (Legal Business Name): DONALD LEE GARRISON JR. CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4977 NORTHCUTT PL
DAYTON OH
45414-3839
US

IV. Provider business mailing address

5224 LINTON ST
ASHVILLE OH
43103-3500
US

V. Phone/Fax

Practice location:
  • Phone: 800-829-5461
  • Fax:
Mailing address:
  • Phone: 614-641-1577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA189757
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: