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General NPI Number Information
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NPI Number | 1174482590
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Entity Type | Organization
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Legal Business Name | LEGACY BOOMERS DRILL AND DRUM CORPS
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Dates
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Enumeration Date | 01/21/2026
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 86 POMEROY AVE
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City | DAYTON
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State | OH
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Zip | 45417-8638
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Country | US
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Telephone | 937-641-9255
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Fax | 937-641-9255
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Provider Business Mailing Address
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Address Line | 86 POMEROY AVE
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City | DAYTON
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State | OH
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Zip | 45417-8638
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Country | US
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Telephone | 937-641-9255
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Fax | 937-641-9255
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY D WILLIAMSON
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Credential | WILLIAMSON
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Telephone | 937-641-9255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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