Healthcare Provider Details

I. General information

NPI: 1437975323
Provider Name (Legal Business Name): ERIN GRIBBEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 JAMES BOHANAN DR
VANDALIA OH
45377-2300
US

IV. Provider business mailing address

2364 TENNESSEE DR
XENIA OH
45385-4733
US

V. Phone/Fax

Practice location:
  • Phone: 937-742-7516
  • Fax:
Mailing address:
  • Phone: 614-582-5596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.220440
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162568
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: