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General NPI Number Information
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NPI Number | 1386136067
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Entity Type | Individual
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Provider Name | DEBORAH MIKINA CDCA
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Gender | Female
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 64 RIDGE AVE
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City | YOUNGSTOWN
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State | OH
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Zip | 44502-1944
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Country | US
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Telephone | 330-743-2192
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Fax |
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Provider Business Mailing Address
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Address Line | 527 N MERIDIAN RD
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City | YOUNGSTOWN
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State | OH
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Zip | 44509-1227
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Country | US
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Telephone |
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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.170406
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License Number State | OH
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