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General NPI Number Information
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NPI Number | 1568229888
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Entity Type | Individual
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Provider Name | SIERRA PACK
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Gender | Female
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 1 TRIANGLE PARK DR
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City | CINCINNATI
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State | OH
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Zip | 45246-3423
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Country | US
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Telephone | 740-656-0943
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Fax |
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Provider Business Mailing Address
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Address Line | 461 STAUNTON JASPER RD SW
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City | WASHINGTON COURT HOUSE
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State | OH
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Zip | 43160-9682
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Country | US
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Telephone | 740-656-0943
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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 | CDCA187020
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License Number State | OH
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