Healthcare Provider Details

I. General information

NPI: 1811340458
Provider Name (Legal Business Name): COURTNIE KAY HOWELL CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 NEAL AVENUE
MT GILEAD OH
43338
US

IV. Provider business mailing address

1791 ALUM CREEK DRIVE
COLUMBUS OH
43207-1708
US

V. Phone/Fax

Practice location:
  • Phone: 419-946-6734
  • Fax: 419-946-6952
Mailing address:
  • Phone: 614-445-8131
  • Fax: 614-827-8380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number050419
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: