Healthcare Provider Details

I. General information

NPI: 1437667045
Provider Name (Legal Business Name): ANGELA DYKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 11/02/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 11TH ST
PORTSMOUTH OH
45662-4531
US

IV. Provider business mailing address

1907 11TH ST
PORTSMOUTH OH
45662-4531
US

V. Phone/Fax

Practice location:
  • Phone: 740-529-7356
  • Fax: 740-529-1354
Mailing address:
  • Phone: 740-529-7356
  • Fax: 740-529-1354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number161914
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1.2405366
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: