Healthcare Provider Details

I. General information

NPI: 1003314113
Provider Name (Legal Business Name): LARRY MUHAMMAD CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1238 COBB AVE
SPRINGFIELD OH
45506-1904
US

IV. Provider business mailing address

1238 COBB AVE
SPRINGFIELD OH
45506-1904
US

V. Phone/Fax

Practice location:
  • Phone: 937-215-0176
  • Fax:
Mailing address:
  • Phone: 937-215-0176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.004553
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.110082
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: