Healthcare Provider Details

I. General information

NPI: 1881311678
Provider Name (Legal Business Name): LOLA MARIA HUNT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LOLA MARIA BUENO

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
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 TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: