Healthcare Provider Details

I. General information

NPI: 1578056396
Provider Name (Legal Business Name): MICHAEL SWEETMAN CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N YELLOW SPRINGS ST
SPRINGFIELD OH
45504-2650
US

IV. Provider business mailing address

201 N YELLOW SPRINGS ST
SPRINGFIELD OH
45504-2650
US

V. Phone/Fax

Practice location:
  • Phone: 513-834-7063
  • Fax: 513-873-1567
Mailing address:
  • Phone: 513-834-7063
  • Fax: 513-873-1567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number161370
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.161370
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: