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General NPI Number Information
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NPI Number | 1215704598
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Entity Type | Individual
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Provider Name | ANDY JAMES KILLIAN CDCA
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Gender | Male
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Dates
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Enumeration Date | 12/07/2023
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 430 N BROADWAY ST STE B
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City | GREEN SPRINGS
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State | OH
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Zip | 44836-9734
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Country | US
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Telephone | 419-307-9128
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Fax |
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Provider Business Mailing Address
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Address Line | 102 WAGNER AVE APT C
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City | SANDUSKY
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State | OH
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Zip | 44870-6319
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Country | US
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Telephone | 419-975-1079
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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.186155
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License Number State | OH
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