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General NPI Number Information
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NPI Number | 1073170130
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Entity Type | Individual
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Provider Name | NICHOLE SNOEBERGER CDCA
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Gender | Female
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 05/23/2019
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Provider Practice Location Address
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Address Line | 1725 E 3RD ST
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City | DAYTON
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State | OH
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Zip | 45403-1850
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Country | US
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Telephone | 937-387-6395
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Fax |
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Provider Business Mailing Address
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Address Line | 7127 SPRINGBORO PIKE APT 2
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City | DAYTON
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State | OH
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Zip | 45449-3655
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Country | US
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Telephone | 937-212-1437
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.170248
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License Number State | OH
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