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General NPI Number Information
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NPI Number | 1588039630
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Entity Type | Individual
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Provider Name | YOLANDA NEWSOME
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Gender | Female
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 1443 STEINER AVE
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City | DAYTON
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State | OH
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Zip | 45417-3813
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Country | US
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Telephone | 937-245-4792
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Fax |
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Provider Business Mailing Address
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Address Line | 328 ALICIA RD
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City | DAYTON
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State | OH
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Zip | 45417-1302
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Country | US
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Telephone | 937-272-3561
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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 | CDCA110773
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License Number State | OH
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