Healthcare Provider Details

I. General information

NPI: 1275290850
Provider Name (Legal Business Name): DANIEL REID HADDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 DELEWARE AVE
MARION OH
43302
US

IV. Provider business mailing address

3433 AGLER RD
COLUMBUS OH
43219-3387
US

V. Phone/Fax

Practice location:
  • Phone: 740-387-7246
  • Fax:
Mailing address:
  • Phone: 614-599-6869
  • Fax:

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: