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General NPI Number Information
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NPI Number | 1245195023
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Entity Type | Individual
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Provider Name | MR. NICHOLAS N EDDY
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Gender | Male
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Dates
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Enumeration Date | 12/23/2025
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 3430 S DIXIE DR STE 308
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City | MORAINE
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State | OH
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Zip | 45439-2316
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Country | US
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Telephone | 937-247-4717
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Fax |
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Provider Business Mailing Address
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Address Line | 233 PERRINE ST
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City | DAYTON
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State | OH
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Zip | 45410-1311
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Country | US
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Telephone | 937-272-1735
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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 | 194518
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License Number State | OH
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