Healthcare Provider Details

I. General information

NPI: 1528865425
Provider Name (Legal Business Name): TEAGAN NICOLE HONSHELL PRS, CDCAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3008 SUDBURY DR
KETTERING OH
45420-1129
US

IV. Provider business mailing address

3008 SUDBURY DR
KETTERING OH
45420-1129
US

V. Phone/Fax

Practice location:
  • Phone: 937-310-1269
  • Fax: 937-310-1199
Mailing address:
  • Phone: 937-310-1269
  • Fax: 937-310-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.191471
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.005715
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: