Healthcare Provider Details

I. General information

NPI: 1124735972
Provider Name (Legal Business Name): NYCHOLE DITMYER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NYCHOLE GAHRIS

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 HARDING ST.
DEFIANCE OH
43512
US

IV. Provider business mailing address

395 HARDING ST.
DEFIANCE OH
43512
US

V. Phone/Fax

Practice location:
  • Phone: 718-954-5653
  • Fax:
Mailing address:
  • Phone: 844-534-3638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2507149
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.188742
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: