=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265364160
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADAM DALTON
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2026
-----------------------------------------------------
Last Update Date | 06/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1521 WALMART DR STE 901
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45036-8359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-496-3014
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1738 BEACON ST APT 3
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45230-2035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | CDCAPRE196218
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------