Healthcare Provider Details

I. General information

NPI: 1245484682
Provider Name (Legal Business Name): ANDREW CHARLES SNYDER LICDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W MAIN ST
SAINT CLAIRSVILLE OH
43950-1040
US

IV. Provider business mailing address

255 W MAIN ST P.O. BOX 118
SAINT CLAIRSVILLE OH
43950-1040
US

V. Phone/Fax

Practice location:
  • Phone: 740-695-9447
  • Fax:
Mailing address:
  • Phone: 740-695-9447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number923248
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: