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General NPI Number Information
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NPI Number | 1427829993
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Entity Type | Individual
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Provider Name | DUSTIN WILLIAM MICHAEL CDCA
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Gender | Male
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Dates
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Enumeration Date | 01/12/2024
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 57 TOWNSHIP HIGHWAY 1275
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City | CHESAPEAKE
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State | OH
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Zip | 45619
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Country | US
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Telephone | 740-451-0307
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Fax |
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Provider Business Mailing Address
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Address Line | 121 MEADOW LN APT D
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City | SOUTH POINT
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State | OH
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Zip | 45680-8628
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Country | US
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Telephone | 740-764-6644
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 187018
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License Number State | OH
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