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General NPI Number Information
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NPI Number | 1447926092
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Entity Type | Individual
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Provider Name | REDINA LEE COUNCE
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Gender | Female
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Dates
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Enumeration Date | 08/23/2021
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 1 ELIZABETH PL FL 3
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City | DAYTON
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State | OH
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Zip | 45417-3445
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Country | US
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Telephone | 937-903-3376
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Fax |
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Provider Business Mailing Address
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Address Line | 216 COLLEGE ST APT C
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City | DAYTON
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State | OH
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Zip | 45402-6903
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Country | US
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Telephone | 937-409-0418
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 0002040
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License Number State | OH
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